Abstract
To update the current state of evidence and assess its quality, we conducted a systematic review on the effects of environmental noise exposure on the cardio-metabolic systems as input for the new WHO environmental noise guidelines for the European Region. We identified 600 references relating to studies on effects of noise from road, rail and air traffic, and wind turbines on the cardio-metabolic system, published between January 2000 and August 2015. Only 61 studies, investigating different end points, included information enabling estimation of exposure response relationships. These studies were used for meta-analyses, and assessments of the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). A majority of the studies concerned traffic noise and hypertension, but most were cross-sectional and suffering from a high risk of bias. The most comprehensive evidence was available for road traffic noise and Ischeamic Heart Diseases (IHD). Combining the results of 7 longitudinal studies revealed a Relative Risk (RR) of 1.08 (95% CI: 1.01–1.15) per 10 dB (LDEN) for the association between road traffic noise and the incidence of IHD. We rated the quality of this evidence as high. Only a few studies reported on the association between transportation noise and stroke, diabetes, and/or obesity. The quality of evidence for these associations was rated from moderate to very low, depending on transportation noise source and outcome. For a comprehensive assessment of the impact of noise exposure on the cardiovascular and metabolic system, we need more and better quality evidence, primarily based on longitudinal studies.
Highlights
A note for the reader: since we carried out the literature search for this systematic review, new studies have been published that investigate the associations between transportation noise exposure and metabolic and cardiovascular disease
We evaluated 40 studies [26,28,30,32,33,35,36,37,40,43,46,49,50,51,55,56,57,60,61,62,63,65,66,67,68,70,73,74,75,76,77,78,80,81,82,83,84,85,86,88,89,90,91,92,94,95,96,97,98,99,101,102,105,106,109,110,112,113,117,118,120,123,126,127,130,131,132,133,134,135,148] that investigated the impact of noise from air, road, and rail traffic and wind turbines on the risk of hypertension
# Since one cross-sectional study was available, we started with a grading of “low” (2); a Response rate was below 60%, and stroke was ascertained by means of a questionnaire only; b NA; c The study assessed population, exposure and outcome of interest; d We considered the results to be imprecise: the 95% CI was considered as sufficiently narrow, we considered the number of cases to be small; e Due to the low number of available effect estimates, it was not possible to test for publication bias or small study bias; f The evaluated study found that the risk of stroke increased when rail traffic noise level increased (RR per 10 dB > 1)
Summary
Several national and international organizations have made recommendations for protecting human health from the adverse effects of environmental noise exposure. The health impact of other noise sources, such as rail traffic and wind turbines, was not addressed in these guidelines. The existing guidelines contain recommendations that deal with the impact of noise on the cardiovascular system. The cardiovascular effects related to noise exposure may be the consequence of a decrease in sleep quality, caused by noise exposure during the night, among other additional or interrelated mechanisms. Such reactions may affect the metabolic system
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