Cardiovascular effects of noise rank second in terms of disability-adjusted life year (DALYs) after annoyance. Although research during the past decade has consolidated the available data base, the most recent meta-analysis still shows wide confidence intervals - indicating imprecise information for public health risk assessment. The alpine area of Tyrol in the Austrian part of the Alps has experienced a massive increase in car and heavy goods traffic (road and rail) during the last 35 years. Over the past 25 years small-, middle-, and large-sized epidemiological health surveys have been conducted - mostly within the framework of environmental health impact assessments. By design, these studies have emphasized a contextually driven environmental stress perspective, where the adverse health effects on account of noise are studied in a broader framework of environmental health, susceptibility, and coping. Furthermore, innovative exposure assessment strategies have been implemented. This article reviews the existing knowledge from these studies over time, and presents the exposure-response curves, with and without interaction assessment, based on standardized re-analyses and discusses it in the light of past and current cardiovascular noise effects research. The findings support relevant moderation by age, gender, and family history in nearly all studies and suggest a strong need for consideration of non-linearity in the exposure-response analyses. On the other hand, air pollution has not played a relevant role as a moderator in the noise-hypertension or the noise-angina pectoris relationship. Finally, different noise modeling procedures can introduce variations in the exposure response curves, with substantive consequences for public health risk assessment of noise exposure.
Although the majority of studies on community noise levels and children's physiological stress responses are positive, effect sizes vary considerably, and some studies do not confirm these effects. Employing a contextual perspective congruent with soundscapes, a carefully constructed sample of children (N = 115, M = 10.1 yr) living in households in relatively high (>60 dBA) or low (<50 dBA) noise areas created by proximity to major traffic arterials in Austria was reanalyzed. Several personal and environmental factors known to affect resting cardiovascular parameters measured under well-controlled, clinical conditions were incorporated into the analyses. Children with premature births and elevated chronic stress (i.e., overnight cortisol) were more susceptible to adverse blood pressure responses to road traffic noise. Residence in a multi-dwelling unit as well as standardized assessments of perceived quietness of the area did not modify the traffic noise impacts but each had its own, independent effect on resting blood pressure. A primary air pollutant associated with traffic volume (NO2) had no influence on any of these results. The scope of environmental noise assessment and management would benefit from incorporation of a more contextualized approach as suggested by the soundscape perspective.
In a short-term experimental study about one-third of subjects exposed to noise shows both increases and decreases in blood pressure. While the association of noise with hypertension is established it is not yet known whether hypotension is associated with noise in field studies. In a cross-sectional study the association of self-reported hypotension and low blood pressure readings with traffic noise was examined in adults (age 25-65, N = 1989, participation = 62%). Noise exposure was based on both, short and long-term day/night recordings and standard noise mapping. Questionnaire data on socio-demographics, housing, life-style, noise and weather sensitivity, health status, mental and physical symptoms were available to adjust for potential confounding and testing for moderation. Non-linear multiple regression was applied to estimate the association between the two outcomes and overall noise exposure. We did not observe a stable relation between noise and low blood pressure readings since the number of subjects based on the recommended cut-off points (5 th percentile or 110 (100)/60 mmHg) was too small. However, self-reported hypotension was non-linearly associated with noise exposure ( P = 0.044) in the presence of a strong sex × age effect modification ( P < 0.0001). Another significant moderation by noise were observed with reported symptoms of exhaustion ( P = 0.03). Weather sensitivity showed a significant interaction with noise sensitivity ( P = 0.02) and also a non-linear interaction with age ( P = 0.02). The results remained stable after adjustment for variables known to be associated with constitutional hypotension. The exposure-effect curve ascends around sound levels of 55 dBA. The results suggest a novel moderated association of noise with self-reported hypotension, predominantly in weather sensitive women with symptoms of exhaustion. Further and larger studies are needed to replicate the potential moderating effect of noise on persons with constitutional hypotension.
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