Urban residential road traffic noise and hypertension: a cross-sectional study of adult population

Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix

During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.

Long-term aircraft noise exposure and risk of hypertension in postmenopausal women

BACKGROUND

Studies of the association between aircraft noise and hypertension are complicated by inadequate control for potential confounders and a lack of longitudinal assessments, and existing evidence is inconclusive.

OBJECTIVES

We evaluated the association between long-term aircraft noise exposure and risk of hypertension among post-menopausal women in the Women's Health Initiative Clinical Trials, an ongoing prospective U.S.

COHORT

METHODS

Day-night average (DNL) and night equivalent sound levels (Lnight) were modeled for 90 U.S. airports from 1995 to 2010 in 5-year intervals using the Aviation Environmental Design Tool and linked to participant geocoded addresses from 1993 to 2010. Participants with modeled exposures ≥45 A-weighted decibels (dB [A]) were considered exposed, and those outside of 45 dB(A) who also did not live in close proximity to unmodeled airports were considered unexposed. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg or inventoried/self-reported antihypertensive medication use. Using time-varying Cox proportional hazards models, we estimated hazard ratios (HRs) for incident hypertension when exposed to DNL or Lnight ≥45 versus <45 dB(A), controlling for sociodemographic, behavioral, and environmental/contextual factors.

RESULTS/DISCUSSION

There were 18,783 participants with non-missing DNL exposure and 14,443 with non-missing Lnight exposure at risk of hypertension. In adjusted models, DNL and Lnight ≥45 db(A) were associated with HRs of 1.00 (95% confidence interval [CI]: 0.93, 1.08) and 1.06 (95%CI: 0.91, 1.24), respectively. There was no evidence supporting a positive exposure-response relationship, and findings were robust in sensitivity analyses. Indications of elevated risk were seen among certain subgroups, such as those living in areas with lower population density (HRinteraction: 0.84; 95%CI: 0.72, 0.98) or nitrogen dioxide concentrations (HRinteraction: 0.82; 95%CI: 0.71, 0.95), which may indicate lower ambient/road traffic noise. Our findings do not suggest a relationship between aircraft noise and incident hypertension among older women in the U.S., though associations in lower ambient noise settings merit further investigation.

Environmental noise and health in low-middle-income-countries: A systematic review of epidemiological evidence

Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of noise guidelines. It is unclear whether findings in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs). We conducted this systematic review to summarise noise epidemiological studies in LMICs. We conducted a literature search of studies in Medline and Web of Science published during 2009-2021, supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation Guide). 58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to 120 dB (L_eq), with over half of the studies (52%) reporting the mean between 60 and 80 dB. The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%) and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had "probably low", 18 (31%) had "probably high" and 36 (62%) had "high" risk of bias. Quality of evidence was rated as 'low' for mental health outcomes and 'very low' for all other outcomes. Strength of evidence for each outcome was assessed as 'inadequate', highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evidence base.

Long-term aircraft noise exposure and risk of hypertension in the Nurses' Health Studies

BACKGROUND

Aircraft noise can affect populations living near airports. Chronic exposure to aircraft noise has been associated with cardiovascular disease, including hypertension. However, previous studies have been limited in their ability to characterize noise exposures over time and to adequately control for confounders.

OBJECTIVES

The aim of this study was to examine the association between aircraft noise and incident hypertension in two cohorts of female nurses, using aircraft noise exposure estimates with high spatial resolution over a 20-year period.

METHODS

We obtained contour maps of modeled aircraft noise levels over time for 90 U.S. airports and linked them with geocoded addresses of participants in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II) to assign noise exposure for 1994-2014 and 1995-2013, respectively. We used time-varying Cox proportional hazards models to estimate hypertension risk associated with time-varying noise exposure (dichotomized at 45 and 55 dB(A)), adjusting for fixed and time-varying confounders. Results from both cohorts were pooled via random effects meta-analysis.

RESULTS

In meta-analyses of parsimonious and fully-adjusted models with aircraft noise dichotomized at 45 dB(A), hazard ratios (HR) for hypertension incidence were 1.04 (95% CI: 1.00, 1.07) and 1.03 (95% CI: 0.99, 1.07), respectively. When dichotomized at 55 dB(A), HRs were 1.10 (95% CI: 1.01, 1.19) and 1.07 (95% CI: 0.98, 1.15), respectively. After conducting fully-adjusted sensitivity analyses limited to years in which particulate matter (PM) was obtained, we observed similar findings. In NHS, the PM-unadjusted HR was 1.01 (95% CI: 0.90, 1.14) and PM-adjusted HR was 1.01 (95% CI: 0.89, 1.14); in NHS II, the PM-unadjusted HR was 1.08 (95% CI: 0.96, 1.22) and the PM-adjusted HR was 1.08 (95% CI: 0.95, 1.21). Overall, in these cohorts, we found marginally suggestive evidence of a positive association between aircraft noise exposure and hypertension.

The relationship between community noise and arterial hypertension in the population of the city of Niš

Aim: The aim of the study was to examine the relationship between noise exposure and the incidence of arterial hypertension as well as the relationship of noise annoyance and noise sensitivity with hypertension. Methods: A cross-sectional questionnaire survey was performed on 911 adult residents of Niš, Serbia, of whom 388 were men (42.6%) and 523 women (57.4%). The criterium for the diagnosis of arterial hypertension was that it was diagnosed by a physician. Based on measurement results of noise, residents, streets were marked as noisy [daily equivalent noise level (Leq) ≥ 55 dB (A) and night Leq ≥ 45 dB (A)] and as quiet [daily equivalent noise level (Leq) ≤ 55 dB (A) and night Leq ≤ 45 dB (A)]. The numerical and verbal noise annoyance scales were used to assess the degree of noise annoyance, while noise sensitivity was measured with the Weinstein's Noise Sensitivity Scale. Results: Arterial hypertension was statistically significantly more frequent in residents in the noisy area compared to residents in the quiet area. After the inclusion of independent variable factors in the logistic regression models, no significant diference was found (p = 0.66, OR = 1.11; 95% CI: 0.69-1.78). A correlation analysis between noise annoyance wich was measured by verbal and numeric scales and arterial hypertension showed a highly significant positive relation. The same case was between the relationship between subjective sensitivity and arterial hipertension. Conclusion: The introduction of the limit for the community noise level that corresponds to the requirements of highly sensitive persons is a significant measure in preventing the harmful effects of noise on the exposed population.

Associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents

BACKGROUND

Epidemiologic evidence linking environmental noise to obesity and hypertension remains scarce, especially in children, and the results remain inconclusive. This study aims to examine the cross-sectional associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents.

METHODS

As an ongoing study, a representative sample of the children aged 6-9 years in Chongqing were selected in 2014. In 2019, self-reported residential noise (answer categories: "very quiet," "moderately quiet," "slightly quiet," and "not at all quiet") data were collected, and 3,412 participants with completed data were included in the analyses.

RESULTS

Participants living in a quieter area had a significantly lower risk of obesity than those living in a noisy area (very quiet: OR = 0.50, 95%CI: 0.29-0.88, P = 0.015; moderately quiet: OR = 0.61, 95%CI: 0.36-1.02, P = 0.059). Similar associations were observed for abdominal obesity, although did not reach statistical significance. Consistently, residential noise exposure was significantly associated with body mass index (BMI) and waist-to-height ratio. Self-reported residential noise exposure was positively associated with systolic blood pressure (β = -1.808; 95%CI = -3.495, -0.110; P = 0.037). When sleep quality, study stress, BMI, and vegetable/fruits consumption were further adjusted, all effect estimates decreased, and no statistical association was observed between noise exposure and blood pressure. Furthermore, we found that the mediating effects of obesity on the associations of self-reported residential noise exposure with hypertension were 6.8% (% of total effect mediated = 0.068, 95%CI: -2.58, 3.99), although did not reach statistical significance.

CONCLUSIONS

Self-reported residential noise exposure was associated with a higher risk of obesity or abdominal obesity. Also, self-reported residential noise exposure was positively associated with hypertension, and obesity may partially mediate this association, but did not reach statistical significance.

Investigating the effects of occupational and environmental noise on cardiovascular diseases: a systematic review and meta-analysis

The present study aimed to use a meta-analysis to investigate the relationship between occupational and non-occupational noise exposure expressed in various studies with cardiovascular disease. This is a systematic review and meta-analysis study based on PRISMA checklist. In this study, the researchers searched five international databases of Medline/PubMed, Embase, Scopus, ISI/web of knowledge, and Google Scholar. Search keywords included two categories noise and noise pollution, cardiovascular disease, and hypertension. The Joanna Briggs Institute checklist was used to review and control the quality of the articles. After all screening stage 139 articles entered the final analysis. The results show that except for East African environmental studies and workplace studies in East Asia, Western Asia, and Northern Europe, there was a significant association between noise exposure and cardiovascular disease. Also, there was a significant difference between the intensity of sound and blood pressure in workers (OR = 1.28, CI 95%: 1.15-1.42, P < 0.001). Based on the results of environmental noise, there was a significant difference between ambient noise intensity and blood pressure (OR = 1.55, CI 95%: 1.53-1.57, P < 0.001). It can be concluded that it is very important to study and identify jobs or living environments with less than the recommended noise level and in addition to hearing aids that occur in over-standard exposures, such as cardiovascular disease.

Association of road traffic noise exposure and prevalence of coronary artery disease: A cross-sectional study in North India

Epidemiological studies have established that noise from transportation sources exceeding the safe limits elevates the risk for cardiovascular diseases. The results however have remained heterogeneous. The present study was conducted to investigate the association between road traffic noise exposure and prevalence of coronary artery disease besides sub-group analysis was performed for identifying the most susceptible population. Traffic noise exposure was measured using the L_den metric in both continuous and categorical forms. A cross-sectional study was performed and information about sociodemographic, lifestyle, and health-related factors was collected. Noise level < 60 dB(A) representing the quiet areas was used as the reference group. Univariate and multivariate logistic regressions were performed to estimate the odds for self-reported coronary artery disease concerning road traffic noise after adjusting for confounding variables. The residents living in noisy areas were found to have a 2.25 times higher risk per 5 dB(A) increment in the noise levels (95% CI = 1.38 to 3.67). Males were at a higher risk of CAD (OR = 2.61; 95% CI = 1.84 to 3.72) as compared to females (OR = 2.07; 95% CI = 1.37-3.13). The subgroup analysis revealed that being sensitive to noise, belonging to a higher age group, reporting higher stress levels, and poor sleep quality were associated with higher risk. The study also provides evidence that exposure to noise levels greater than 60 dB(A) is associated with the prevalence of coronary artery disease in adults.

Sex/Gender-Differences in the Health Effects of Environmental Noise Exposure on Hypertension and Ischemic Heart Disease-A Systematic Review

Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms “sex” and “gender” were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.

Effects of Exposure to Road, Railway, Airport and Recreational Noise on Blood Pressure and Hypertension

Noise is one of the most diffused environmental stressors affecting modern life. As such, the scientific community is committed to studying the main emission and transmission mechanisms aiming at reducing citizens' exposure, but is also actively studying the effects that noise has on health. However, scientific literature lacks data on multiple sources of noise and cardiovascular outcomes. The present cross-sectional study aims to evaluate the impact that different types of noise source (road, railway, airport and recreational) in an urban context have on blood pressure variations and hypertension. 517 citizens of Pisa, Italy, were subjected to a structured questionnaire and five measures of blood pressure in one day. Participants were living in the same building for at least 5 years, were aged from 37 to 72 years old and were exposed to one or more noise sources among air traffic, road traffic, railway and recreational noise. Logistic and multivariate linear regression models have been applied in order to assess the association between exposures and health outcomes. The analyses showed that prevalence of high levels of diastolic blood pressure (DBP) is consistent with an increase of 5 dB (A) of night-time noise (β = 0.50 95% CI: 0.18-0.81). Furthermore, increased DBP is also positively associated with more noise sensitive subjects, older than 65 years old, without domestic noise protection, or who never close windows. Among the various noise sources, railway noise was found to be the most associated with DBP (β = 0.68; 95% CI: -1.36, 2.72). The obtained relation between DBP and night-time noise levels reinforces current knowledge.

Noise annoyance, sociodemographic and health patterns, and neighborhood perceptions in a Brazilian metropolis: BH Health Study

OBJECTIVE

The present study aims to analyze the association of noise annoyance with individual and sociodemographic factors and self-perception of the neighborhood in an urban center.

METHODS

Data were collected through a population-based cross-sectional study held in two of the nine health districts in the city of Belo Horizonte, Minas Gerais, Brazil, from 2008 to 2009. The study included 3,934 individuals of both genders, aged 18 years and older. The response variable was the self-perception of noise, investigated by the question: "In your neighborhood, does the noise bother you?" The explanatory variables were grouped into the following domains: sociodemographic, social determinants, self-rated health, and self-reported diseases.

RESULTS

The prevalence of noise annoyance was 47% for women and 39.8% for men. For both genders, noise annoyance was independently associated with bad traffic and the presence of loud music, discussions, and late-night parties.

CONCLUSION

Gender differences were identified in the association of noise annoyance with sociodemographic characteristics and self-reported morbidity. Traffic and social customs were the main sources of noise in the regions under study.

[Epidemiological Studies on the Association between Chronic Exposure to Road Traffic Noise and Blood Pressure: A Systematic Review with Meta-Analyses]

AIM

The aim of this study was to review epidemiological studies on the association between chronic exposures to road traffic noise and prevalence of arterial hypertension as well as blood pressure by using meta-analyses.

METHODS

A systematic literature search in the databases Medline^® and Web of science™ as well as the database OpenGrey was conducted to identify suitable studies, namely epidemiological observational studies assessing objective exposures to road traffic noise at the subject's home place with analysis of their potential associations with arterial hypertension or blood pressure. Whenever possible, overall effects for the different relationships were estimated with meta-analyses. For statistical analyses R for windows was used.

RESULTS

A total of 31 eligible studies were identified. Meta-analyses were conducted for potential association between road traffic noise and prevalence of arterial hypertension in adults and for association with systolic and diastolic blood pressure in adults and children. There was a significant (p<0.01) increase of risk for arterial hypertension in adults when exposed to chronic road traffic noise with an increment of 7% per 5 dB(A). Overall effects for systolic blood pressure were positive but weak for children as well as adults without any statistical significance. For diastolic blood pressure there appeared to be no relationship with chronic exposure to road traffic noise in either of the two groups.

CONCLUSION

Considering the multiple methodological limitations of studies examined as well as the high level of heterogeneity in all random effects models, the estimated overall effects must be interpreted with caution. To examine potential associations between road traffic noise and arterial hypertension or measured blood pressure appropriately, more prospective cohort studies are necessary with precise assessments of noise exposure as well as clinical endpoints and with adjustments for relevant cofactors.

Evidence Relating to Environmental Noise Exposure and Annoyance, Sleep Disturbance, Cardio-Vascular and Metabolic Health Outcomes in the Context of IGCB (N): A Scoping Review of New Evidence

WHO published the Environmental Noise Guidelines for the European Region in 2018, based on seven systematic reviews including studies published between 2000 and 2014. Since then, new studies were published. At the request of the UK Department for Environment, Food and Rural Affairs (DEFRA), a review on annoyance, sleep disturbance, cardiovascular and metabolic effects in relation to environmental noise was prepared. The aim was to advise the Interdepartmental Group on Costs and Benefits Noise Subject Group (IGCB(N)) whether this new evidence warrants an update of their recommendations. Four databases for observational studies were screened and data were extracted on design, type and measurements of exposures and outcomes and confounders and their associations. The quality of the studies was indirectly assessed for cardiovascular and metabolic effects by only including studies with a case control or cohort design. For studies on annoyance and sleep disturbance, the risk of bias was expressed in exposure misclassification, selective participation and confounding. The update yielded 87 papers, pertaining to 108 new studies of which 40 new studies were on annoyance, 42 on sleep disturbance and 26 concerning cardiovascular and metabolic effects. The number, size and quality of the new studies suggest new meta-analyses could be undertaken over the sources and effects included in the WHO reviews.

Association between the living environment and the risk of arterial hypertension and other components of metabolic syndrome

Background

Metabolic syndrome (MS) is characterized by numerous metabolic risk factors. We investigated the associations between a long-term exposure to ambient air pollution and the residential distance to green spaces (GS) and major roads with the development of arterial hypertension (AH) and some components of MS. These associations were assessed among persons living in private and multi-story houses (MH).

Methods

We selected 1354 participants for the population study from MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease Program). The exposures to PM10, PM2.5, and NO2 levels were assessed by using the LUR models for Kaunas City.

Results

In the participants who lived in MH, the residential distance to a major road closer than 200 m and the residential exposure to PM10 and PM2.5 levels above the median were associated with a higher risk of AH (the adjusted relative risks (RRs), respectively, were 1.41(1.10–1.81), 1.19(1.01–1.42) and 1.27(1.07–1.52)). In these participants, the residential exposure to a PM10 level above the median was associated with a higher risk of reduced high density lipoprotein (RHDL) (RR = 1.46(1.05–2.05)). A negative impact of the traffic air pollutants on the incidence of AH, RHDL cholesterol and high triglyceride levels was observed only in the participants who lived in MH.

Association between exposure to noise and risk of hypertension: a meta-analysis of observational epidemiological studies

OBJECTIVE

An increasing amount of original studies suggested that exposure to noise could be associated with the risk of hypertension, but the results remain inconsistent and inconclusive. We aimed to synthesize available epidemiological evidence about the relationship between various types of noise and hypertension, and to explore the potential dose-response relationship between them in an up-to-date meta-analysis.

METHODS

We conducted a literature search of PubMed and Embase from these databases' inception through December 2016 to identify observational epidemiological studies examining the association between noise and risk of hypertension. A random effects model was used to combine the results of included studies. Dose-response meta-analysis was conducted to examine the potential dose-response relationship.

RESULTS

In total, 32 studies (five cohort studies, one case-control study, and 26 cross-section studies) involving 264 678 participants were eligible for inclusion. Pooled result showed that living or working in environment with noise exposure was significantly associated with increased risk of hypertension (odds ratio 1.62; 95% confidence interval: 1.40-1.88). We found no evidence of a curve linear association between noise and risk of hypertension. A dose-response analysis suggested that, for an increment of per 10 dB(A) of noise, the combined odds ratio of hypertension was 1.06 (95% confidence interval: 1.04-1.08).

CONCLUSION

Integrated epidemiological evidence supports the hypothesis that exposure to noise may be a risk factor of hypertension, and there is a positive dose-response association between them.

Effects of occupational exposure to noise and dust on blood pressure in Chinese industrial workers

Along with the rapid development of economy and urbanization, noise and air pollution are becoming major occupational health hazards in the process of industrial production. In this study, we collected data from 7293 industrial workers in China. The association between occupational exposure of noise and dust and blood pressure was investigated. Controlling for demographic variables, including sex, age, and length of service, a stepwise regression model with backward elimination was constructed. The results showed that both noise and dust decreased the level of systolic blood pressure (p < 0.001). This finding prompted the manufacturing industry to reduce noise and dust hazards and protect the occupational health of workers. Prospective studies in different populations are still required to verify the net contribution of noise and dust to the decrease in blood pressure.

Local Actors' Frames of the Role of Living Conditions in Shaping Hypertension Risk and Disparities in a Colombian Municipality

Conditions in the social and physical environment influence population health and risk for CVD, including hypertension. These environmental conditions are influenced by the decisions of public officials, community leaders, and service providers. Examining the frames that local decision makers bring to understanding hypertension can provide important insights into the decisions that they make about strategies for addressing this problem in their jurisdiction. The goal of this study was to examine the frames that local decision makers in Quibdó, Colombia, bring to understanding hypertension risk, and in particular, whether and how they use frames that encompass associations between living conditions and hypertension risk. Data for this qualitative study were collected using a stratified sampling strategy. Semi-structured interviews were conducted in 2012 with 13 local decision makers and analyzed using a framework approach. Participants linked the structural conditions experienced in Quibdó, including displacement, limited economic opportunities, and the infrastructure of the city, to hypertension risk through multiple pathways, including behavioral risk factors for hypertension and physiologic responses to stress. They described the social patterning of these factors across socioeconomic, racial/ethnic, and gender hierarchies. Although several conditions associated with hypertension risk are widely distributed in the city's population, social processes of marginalization and stratification create additional disadvantages for those on the lower rungs of the social hierarchy.