A dose response relation for noise induced hypertension

Impact of Noise Exposure on Risk of Developing Stress-Related Health Effects Related to the Cardiovascular System: A Systematic Review and Meta-Analysis

Background

: Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses.

Materials and Methods

This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

: The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects.

Conclusions

: This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.

The prevalence of occupational exposure to noise: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BACKGROUND

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic and human data suggests that occupational exposure to noise may cause cardiovascular disease. In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to noise for estimating (if feasible) the number of deaths and disability-adjusted life years from cardiovascular disease that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates.

OBJECTIVES

We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to noise.

DATA SOURCES

We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines, and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts.

STUDY ELIGIBILITY AND CRITERIA

We included working-age (≥15 years) workers in the formal and informal economies in any WHO Member and/or ILO member State, but excluded children (<15 years) and unpaid domestic workers. We included all study types with an estimate of the prevalence of occupational exposure to noise, categorized into two levels: no (low) occupational exposure to noise (<85dBA) and any (high) occupational exposure to noise (≥85dBA).

STUDY APPRAISAL AND SYNTHESIS METHODS

At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the RoB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates.

RESULTS

Sixty-five studies (56 cross-sectional studies and nine cohort studies) met the inclusion criteria, comprising 157,370 participants (15,369 females) across 28 countries and all six WHO regions (Africa, Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). For the main analyses, we prioritized the four included studies that surveyed national probability samples of general populations of workers over the 58 studies of workers in industrial sectors and/or occupations with relatively high occupational exposure to noise. The exposure was generally assessed with dosimetry, sound level meter, or official or company records; in the population-based studies, it was assessed with validated questions. Estimates of the prevalence of occupational exposure to noise are presented for all 65 included studies, by country, sex, 5-year age group, industrial sector, and occupation where feasible. The pooled prevalence of any (high) occupational exposure to noise (≥85dBA) among the general population of workers was 0.17 (95% confidence interval 0.16 to 0.19, 4 studies, 108,256 participants, 38 countries, two WHO regions, I2 98%, low quality of evidence). Subgroup analyses showed that pooled prevalence differed substantially by WHO region, sex, industrial sector, and occupation.

CONCLUSIONS

Our systematic review and meta-analysis found that occupational exposure to noise is prevalent among general populations of workers. The current body of evidence is, however, of low quality, due to serious concerns for risk of bias and indirectness. Producing estimates of occupational exposure to noise nevertheless appears evidence-based, and the pooled effect estimates presented in this systematic review are suitable as input data for the WHO/ILO Joint Estimates (if feasible). Protocol identifier: 10.1016/j.envint.2018.09.040 PROSPERO registration number: CRD42018092272.

Occupational Noise and Hypertension Risk: A Systematic Review and Meta-Analysis

A number of epidemiological studies report an association between occupational noise exposure and arterial hypertension. Existing systematic reviews report conflicting results, so we conducted an updated systematic review with meta-analysis. We registered the review protocol with PROSPERO (registration no.: CRD 42019147923) and searched for observational epidemiological studies in literature databases (Medline, Embase, Scopus, Web of Science). Two independent reviewers screened the titles/abstracts and full texts of the studies. Two reviewers also did the quality assessment and data extraction. Studies without adequate information on recruitment, response, or without a comparison group that was exposed to occupational noise under 80 dB(A) were excluded. The literature search yielded 4583 studies, and 58 studies were found through hand searching. Twenty-four studies were included in the review. The meta-analysis found a pooled effect size (ES) for hypertension (systolic/diastolic blood pressure ≥140/90 mmHg) due to noise exposures ≥80 dB(A) of 1.81 (95% CI 1.51–2.18). There is no substantial risk difference between men and women, but data concerning this question are limited. We found a positive dose-response-relationship: ES = 1.21 (95% CI 0.78–1.87) ≤ 80 dB(A), ES = 1.77 (95% CI 1.36–2.29) > 80–≤85 dB(A), and ES = 3.50 (95% CI 1.56–7.86) > 85–≤90 dB(A). We found high quality of evidence that occupational noise exposure increases the risk of hypertension.

Noise exposure limit for children in recreational settings: Review of available evidence

It is universally recognized that prolonged exposure to high levels of non-impulsive noise will lead to noise-induced hearing loss. These high levels of noise have traditionally been found in an occupational setting, but exposure to high levels of noise is increasingly common in recreational settings. There is currently no established acceptable risk of hearing loss in children. This review assumed that the most appropriate exposure limit for recreational noise exposure in children would be developed to protect 99% of children from hearing loss exceeding 5 dB at the 4 kHz audiometric test frequency after 18 years of noise exposure. Using the ISO 1999:2013 model for predicting hearing loss, it was estimated that noise exposure equivalent to an 8-h average exposure (L_EX) of 82 dBA would result in about 4.2 dB or less of hearing loss in 99% of children after 18 years of exposure. The 8-h L_EX was reduced to 80 dB to include a 2 dB margin of safety. This 8-h L_EX of 80 dBA is estimated to result in 2.1 dB or less of hearing loss in 99% of children after 18 years of exposure. This is equivalent to 75 dBA as a 24-h equivalent continuous average sound level.

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Despite the implications of gender and sex differences for health risks associated with blue-collar work, adverse health outcomes among blue-collar workers has been most frequently studied among men. The present study provides a "state-of-the-field" systematic review of the empiric evidence published on blue-collar women's health. We systematically reviewed literature related to the health of blue-collar women published between January 1, 1990 and December 31, 2015. We limited our review to peer-reviewed studies published in the English language on the health or health behaviors of women who were presently working or had previously worked in a blue-collar job. Studies were eligible for inclusion regardless of the number, age, or geographic region of blue-collar women in the study sample. We retained 177 studies that considered a wide range of health outcomes in study populations from 40 different countries. Overall, these studies suggested inferior health among female blue-collar workers as compared with either blue-collar males or other women. However, we noted several methodological limitations in addition to heterogeneity in study context and design, which inhibited comparison of results across publications. Methodological limitations of the extant literature, alongside the rapidly changing nature of women in the workplace, motivate further study on the health of blue-collar women. Efforts to identify specific mechanisms by which blue-collar work predisposes women to adverse health may be particularly valuable in informing future workplace-based and policy-level interventions.

Human response to vibration stress in Japanese workers: lessons from our 35-year studies A narrative review

The occupational uses with vibratory tools or vehicles provoked health disorders of users. We reviewed narratively our articles of 35 yr studies and their related literatures, and considered the pathophysiology of the hand-arm vibration disorders. Concerning the risk factors of health impairments in workers with vibratory tools, there are two conflicting schools of the researchers: The peripheral school emphasizes that vibration only makes predominant impairments on hands and arms, showing typically Raynaud's phenomenon in the fingers. In the systemic school, the health disorders are produced by combination with vibration, noise and working environment, namely vibratory work itself, leading to diversified symptoms and signs in relation to systemic impairments. Our 35 yr studies have evidently supported the systemic school, including disorders of the central and autonomic nervous systems. The genesis is vibratory work itself, including vibration, noise, cold working environment, ergonomic and biodynamic conditions, and emotional stress in work. Because the health disorders yield in the whole body, the following measures would contribute to the prevention of health impairments: the attenuation of vibration and noise generated form vibratory machines and the regulations on operating tool hours. In conclusion, this occupational disease results from systemic impairments due to long-term occupational work with vibratory tools.

Objective and subjective socioeconomic gradients exist for sleep quality, sleep latency, sleep duration, weekend oversleep, and daytime sleepiness in adults

Socioeconomic gradients exist for multiple health outcomes. Lower objective socioeconomic position (SEP), whether measured by income, education, or occupation, is associated with inadequate sleep. Less is known about whether one's perceived ranking of their social status, or subjective SEP, affects sleep. This study examined whether a subjective socioeconomic gradient exists for sleep while controlling for objective SEP. Participants (N = 177; age, M = 45.3 years, SD = 6.3 years) completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, MacArthur Ladder, and other self-report measures to assess sleep and objective SEP. Subjective SEP trumped objective SEP as a better predictor of sleep duration, daytime sleepiness, and weekend oversleep. These findings highlight the need to expand our framework to better understand the mechanisms underlying socioeconomic gradients and sleep.

High-frequency hearing loss, occupational noise exposure and hypertension: a cross-sectional study in male workers

BACKGROUND

The association between occupational noise exposure and hypertension is inconsistent because of an exposure bias caused by outer-ear measurements of noise levels among workers. This study used hearing loss values (HLVs) measured at 4 kHz and 6 kHz in both ears as a biomarker to investigate the chronic effects of noise exposure on hypertension in 790 aircraft-manufacturing workers.

METHODS

Participants were divided into a high hearing loss (HL) group (n = 214; average HLVs ≥ 30 decibel [dB] at 4 kHz or 6 kHz bilaterally; 83.1 ± 4.9 A-weighted decibel [dBA]), a median HL group (n = 302; 15 ≤ average HLVs < 30 dB at 4 kHz or 6 kHz bilaterally; 83.1 ± 4.4 dBA) and a low HL group (n = 274; average HLVs < 15 dB at 4 kHz or 6 kHz bilaterally; 82.2 ± 5.1 dBA) based on the results of pure tone audiometry. Multivariate logistic regressions were used to estimate the risk of hypertension between groups.

RESULTS

The prevalence rates of hypertension were significantly higher in the high HL (43.5%; p = 0.021) and median HL (42.1%; p = 0.029) groups than in the low HL group (33.2%). The high HL and median HL workers had 1.48-fold (95% confidence interval [95%CI] = 1.02-2.15; p = 0.040) and 1.46-fold (95%CI = 1.03-2.05; p = 0.031) higher risks of hypertension relative to the low HL workers. Employment duration was significantly and positively correlated with the risk of hypertension among workers with average HLVs ≥ 15 dB at 4 kHz (p < 0.001) and 6 kHz (p < 0.001) bilaterally.

CONCLUSIONS

Our findings suggest that high-frequency hearing loss is a good biomarker of occupational noise exposure and that noise-induced hearing loss may be associated with the risk of hypertension.

Effects of occupational noise exposure on 24-hour ambulatory vascular properties in male workers

BACKGROUND

Epidemiologic studies have demonstrated that occupational noise exposure is associated with hypertension, but the related mechanism in vascular structural changes is unclear.

OBJECTIVE

This panel study aimed to investigate effects of occupational noise exposure on ambulatory vascular structural properties in male workers.

METHODS

We recruited 20 volunteers and divided them into a high-noise-exposure group of 15 and a low-noise-exposure group of 5 based on environmental noise measurement in an automobile manufacturing company. We determined individual noise exposure and measured personal ambulatory vascular property parameters simultaneously during 24 hr. Linear mixed-effects regression models were used to estimate transient and sustained effects of noise exposure on vascular parameters by adjusting some confounders collected from self-administrated questionnaires and health checkups.

RESULTS

The high-noise-exposed (85 +/- 8 dBA) workers had significantly higher systemic vascular resistance (SVR) than the low-noise-exposed workers (59 +/- 4 dBA) during work and sleep periods. Contrarily, low-noise-exposed workers had significantly higher brachial artery compliance (BAC), brachial artery distensibility (BAD), and systemic vascular compliance (SVC; marginal, p = 0.07) than high-noise-exposed workers during off-duty periods. We also found that high-noise-exposed workers had significantly lower BAC (1.38 +/- 0.55 %mL/mmHg) and BAD (1.29 +/- 0.51 %/mmHg), as well as lower SVC (0.24 +/- 0.10 mL/L/mmHg), but higher SVR (1.93 +/- 0.67 mL/L/min) compared with low-noise-exposed workers over a 24-hr period.

CONCLUSIONS

Our findings suggest that in automobile workers, occupational noise exposure may have sustained, not transient, effects on vascular properties and also enhances the development of hypertension.

Effects of Occupational Noise Exposure on Blood Pressure

We measured 24-hour ambulatory blood pressure and 16-hour noise exposure continuously for 20 automobile workers, and used linear mixed-effects regression models to estimate transient and sustained effects of noise exposure on blood pressure. The occupational noise levels of the high-exposure workers with 85 +/- 8 dBA were significantly higher than those of the low-exposure workers with 59 +/- 4 dBA (P < 0.05). We found a significant difference of 16 +/- 6 mm Hg in sleep-time systolic blood pressure (SBP) existed between 2 exposure groups, and a marginal increase of 1 mm Hg SBP per 1-dBA increase in occupational noise exposure at a 60-minute lag time during work (P = 0.07). Occupational noise exposure had both transient and sustained effects on workers' SBP.

Noise pollution: non-auditory effects on health

Noise is a prominent feature of the environment including noise from transport, industry and neighbours. Exposure to transport noise disturbs sleep in the laboratory, but not generally in field studies where adaptation occurs. Noise interferes in complex task performance, modifies social behaviour and causes annoyance. Studies of occupational and environmental noise exposure suggest an association with hypertension, whereas community studies show only weak relationships between noise and cardiovascular disease. Aircraft and road traffic noise exposure are associated with psychological symptoms but not with clinically defined psychiatric disorder. In both industrial studies and community studies, noise exposure is related to raised catecholamine secretion. In children, chronic aircraft noise exposure impairs reading comprehension and long-term memory and may be associated with raised blood pressure. Further research is needed examining coping strategies and the possible health consequences of adaptation to noise.

The association between noise exposure and blood pressure and ischemic heart disease: a meta-analysis

It has been suggested that noise exposure is associated with blood pressure changes and ischemic heart disease risk, but epidemiologic evidence is still limited. Furthermore, most reviews investigating these relations were not carried out in a systematic way, which makes them more prone to bias. We conducted a meta-analysis of 43 epidemiologic studies published between 1970 and 1999 that investigate the relation between noise exposure (both occupational and community) and blood pressure and/or ischemic heart disease (International Classification of Diseases, Ninth Revision, codes 410-414). We studied a wide range of effects, from blood pressure changes to a myocardial infarction. With respect to the association between noise exposure and blood pressure, small blood pressure differences were evident. Our meta-analysis showed a significant association for both occupational noise exposure and air traffic noise exposure and hypertension: We estimated relative risks per 5 dB(A) noise increase of 1.14 (1.01-1.29) and 1.26 (1.14-1.39), respectively. Air traffic noise exposure was positively associated with the consultation of a general practitioner or specialist, the use of cardiovascular medicines, and angina pectoris. In cross-sectional studies, road traffic noise exposure increases the risk of myocardial infarction and total ischemic heart disease. Although we can conclude that noise exposure can contribute to the prevalence of cardiovascular disease, the evidence for a relation between noise exposure and ischemic heart disease is still inconclusive because of the limitations in exposure characterization, adjustment for important confounders, and the occurrence of publication bias.

Increased prevalence of hypertension in a population exposed to aircraft noise

OBJECTIVES

To investigate whether there is a relation between residential exposure to aircraft noise and hypertension.

METHODS

The study population comprised two random samples of subjects aged 19-80 years, one including 266 residents in the vicinity of Stockholm Arlanda airport, and another comprising 2693 inhabitants in other parts of Stockholm county. The subjects were classified according to the time weighted equal energy and maximum aircraft noise levels at their residence. A questionnaire provided information on individual characteristics including history of hypertension.

RESULTS

The prevalence odds ratio for hypertension adjusted for age, sex, smoking, and education was 1.6 (95% confidence interval (95% CI) 1.0 to 2.5) among those with energy averaged aircraft noise levels exceeding 55 dBA, and 1.8 (95% CI 1.1 to 2.8) among those with maximum aircraft noise levels exceeding 72 dBA. An exposure-response relation was suggested for both exposure measures. The exposure to aircraft noise seemed particularly important for older subjects and for those not reporting impaired hearing ability.

CONCLUSIONS

Community exposure to aircraft noise may be associated with hypertension.

Comparison of blood pressure in deaf-mute children and children with normal hearing: association between noise and blood pressure

The present study assessed the relationship between noise exposure and blood pressure. The study population consisted of 892 children from two elementary schools. The noise-sensitive group comprised 583 subjects with normal hearing from one school, while the noise-insensitive group comprised 309 deaf-mutes from another school. The deaf subjects had significantly lower blood pressure than the subjects with normal hearing (P < 0.05) after adjustment for age. Multiple regression analysis revealed that body mass index, age, and hearing ability explained a significant amount of the variation in systolic and diastolic blood pressure (R2 = 0.17 and 0.16, respectively). On the basis of the results, it is suggested that noise exposure is associated with higher systolic and diastolic blood pressure.