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Meeting of the Eionet National Reference Centres for Noise Copenhagen, 14 th - 15 th October 2009 Linking Exposure To Health Wolfgang Babisch Martin van.

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Presentation on theme: "Meeting of the Eionet National Reference Centres for Noise Copenhagen, 14 th - 15 th October 2009 Linking Exposure To Health Wolfgang Babisch Martin van."— Presentation transcript:

1 Meeting of the Eionet National Reference Centres for Noise Copenhagen, 14 th - 15 th October 2009 Linking Exposure To Health Wolfgang Babisch Martin van den Berg European Environment Agency Expert Panel on Noise (EPoN) European Environment Information and Observation Network

2 Calm Network Vision for the Year 2020 Source: CALM, 2004 Avoid harmful effects of noise exposure from all sources and preserve quiet areas. Community Research Strategy Plan Coordination of European Research for Advanced Transport Noise Mitigation

3 WHO Constitution (1948): Health is a state of complete l physical l mental and l social well-being and not merely the absence of disease or infirmity. Health

4 Well-being and Ill-health

5 Introduction Health endpoints Exposure-response curves Risk assessment Cost-benefit analysis Implications for END References Expert Panel on Noise (EPoN) Fact Sheet Fact-sheet on Noise Exposure and Potential Health Impact

6 Introduction Health endpoints Exposure-response curves Risk assessment Cost-benefit analysis Implications for END References Expert Panel on Noise (EPoN) Fact Sheet Fact-sheet on Noise Exposure and Potential Health Impact

7 Hazard identification Exposure-response assessment Exposure assessment Risk characterization Attributable risk concept Risk management Regulatory options Quantitative Risk Assessment END ?Link Research !

8 Hearing loss Annoyance Sleep disturbance (objective and subjective) Cognitive impairment Mental health Physiological stress reaction Cardiovascular risk Health Endpoints "Hazard Identification"

9 Source: Miedema and Oudshoorn, 2001 European Commission Working Group on Dose-Effect Relations, %-Criterion Common rule WHO Community Noise Guidelines (1999): "Serious annoyance" Annoyance "Highly Annoyed"

10 Aircraft noise Δ = 7-8 dB(A) Road traffic noise Change of Annoyance "Hyena Study" Source: Babisch et al., 2009

11 Annoyance Due To Aircraft Noise Update "Little annoyed""Highly annoyed""Annoyed" Source: TNO, 2009 Older studies Newer studies included

12 Sleep Normal sleep Noise disturbed sleep Source: Maschke et al., 2000

13 Sleep Disturbance (Objective) Awakenings (Single Aircraft Flyover) – "DLR Laboratory Study" (Changes to wake or to sleep-stage S1 within 90 seconds) Maximum Sound Pressure Level L AS,max [dB] Source: Basner et al., 2006 Probability of sleep stage changes to awake Spontaneous awakening Noise induced awakening 33 dB

14 Sleep Disturbance (Objective) Aircraft Noise Simulation – "DLR Field Study" Source: Basner and Griefahn, 2008 Moderate Effects in Vulnerable Groups Steep Increase of Adverse Effects Public Health Hazard L night, outside (aircraft) Figure 1: The average number of additionally aircraft noise induced awakenings per night. Altogether, 10 million 8-hour nights with 1 to 200 (1, 2, 3,…, 200) noise events randomly drawn from the DLR field study 20 were simulated. The lines represent (from below to above) 2.5, 25, 50, 75, and 97.5 percentiles. In an 8 h undisturbed night of a healthy sleeper, on average 24 spontaneous EEG awakenings (as defined by Rechtschaffen and Kales1) can be observed (equaling 8,760 spontaneous awakenings per year). 365 EEG awakenings per year

15 Noise and transient sleep disturbance - well developed area with statistically robust data and dose-response relationships. No quantitative link yet established between acute or transient sleep disturbance caused by noise and any long term adverse health effects. No consensus on any single dose-response relationship which could be used to inform cost benefit analysis, monetary evaluation of adverse health effects, policy etc. Sleep Disturbance Health (?) Source: Bell report, 2009 Griefahn and Basner (Internoise), 2009

16 Cross-sectional study, 1718 males and females, aged yrs Relative prevalence of treated high blood pressure by road traffic noise level Significant effects only with respect to the exposure of the bedroom OR = 1.9 Day - Living roomNight - Bedroom Source: UBA - Maschke et al. (2003) Hypertension "Spandau Health Survey"

17 Noise level (Lnight) [dBA] Percent highly sleep disturbed (HSD) [%] Aircraft Road Railway 5%-Criterion (?) WHO Community Noise Guidelines (1999): "Sleep disturbance, window open" Source: Miedema and Oudshoorn, 2001 European Commission Working Group on Health and Socio-Economic Aspects, 2004 Sleep Disturbance (Subjective) "Highly Sleep Disturbed" WHO Night Noise Guidelines For Europe (2009): "Night noise guideline"

18 Source: Hygge et al., 2002 no noise noise Difficult word list, 326 children Old airport Wave 1Wave 2Wave 3 Old airport closed Mean errors New airport Mean errors Wave 1Wave 2Wave 3 New airport opened Mean errors Cognitive Impairment "Munich Study"

19 Source: Stansfeld et al., children Reading Comprehension "Ranch Study" Aircraft noise at school L Aeq,16h [dB] Aircraft noise associated with deficits in reading comprehension and recognition memory Reading Z-score

20 Noise Working memory Episodic memory Read Listen Phonological loop Visual loop Basic Memory Model Read – Listen - Learn It could be noted that: Both chronic noise exposure in the field study and acute noise exposure in the experiments impair episodic memory, in particular recall. There is a strong similarity in how much and in what way children and adults are affected by noise. Staffan Hygge Source: Hygge, 2009 (presentation in Helsinki) L dn

21 Assuming that 100% of the noise exposed are cognitively affected at a very high noise level, e.g. 95 Ldn, and that none are affected at a safely low level, e.g. 50 Ldn, a straight line (linear accumulation) connecting these two points, as in the Figure below can be used as basis for approximation. Hypothetical Exposure-Response Curve - Cognitively Affected - Source: Hygge, 2009 (presentation in Helsinki) Staffan Hygge

22 No evidence Mental Health v. Kamp and Davies (2008): "... there is no direct association between environmental noise and mental health". "Noise annoyance is consistently found to be an important mediator." Clark and Stansfeld (2007): "Overall, studies suggest that both adults and children noise exposure is probably not associated with serious psychological illness, but there may be effects on well-being and quality of life." Source: Bell report, 2009

23 Source: Henry & Stephens, 1977 Perceived Stimulus Coping Patterns Early Experience Genetics Fight - Flight Nervous System + Adrenaline + Noradrenaline o Cortisol Hypophysis (Pituitary Gland) + ACTH + Cortisol o Catecholamines Depression Threat to Control Loss of Control Sympathetic-Adrenal-Medullar Axis Hypophysio-Pituitary-Adrenal-Cortical Axis Stress Model

24 Cross-sectional study, 195 females, aged yrs Overnight excretion of norepinephrine in urine by road traffic volume Mean +/- SE <14,000 (mean = 2,300)>20,000 (mean = 31,000) Traffic volume [vehicles/day] Noradrenaline per Creatinine [µg/g] Source: Babisch et al. (2001) L Aeq,24h < 60 dBL Aeq,24h > 65 dB Stress Hormones "Berlin Traffic and Health Study"

25 -With respect to environmental noise acute noise effects occur, in particular, when certain activities such as concentration, relaxation or sleep are disturbed. -Even subjects that have been living for many years in exposed homes show physiological stress reactions. -During sleep no complete habituation takes place. Even subjects who are subjectively disturbed by the noise show acute physiological reactions to single noise events. Figure: Maschke, 2004 Habituation / Adaption

26 Sound exposure Disturbance of intended activities Stress indicators Biological risk factors Cardiovascular diseases Noise Exposure (Sound Level) Direct pathwayIndirect pathway Hearing loss Disturbance of activities, sleep communication Cognitive and emotional response Annoy- ance Autonomic nervous system (sympathetic nerve) Endocrine system (pituitary gland, adrenal gland) Cardiovascular Diseases Hypertension Arteriosclerosis Ischaemic heart diseases Stress Indicators Risk Factors Blood pressureBlood lipidsBlood viscosity Cardiac outputBlood glucoseBlood clotting factors Manifest Disorders Physiological stress reactions (homeostasis) Simplified Noise Reaction Model Source: Babisch, 2002

27 Cross-sectional study, 4860 males, aged yrs Relative concentration of serum cholesterol by road traffic noise Source: Babisch et al., 1993 Traffic noise level L day,16h [dB(A)] Serum Cholesterol "Caerphilly & Speedwell Studies"

28 Cross-sectional study, 4860 males, aged yrs Relative concentration of plasma viscosity by road traffic noise Traffic noise level L day,16h [dB(A)] Source: Babisch et al., 1993 Plasma Viscosity "Caerphilly & Speedwell Studies"

29 Source: Babisch, 2006 Traffic noise level L day,12hr [dB(A)] Heterogeneity: p = Exposure-Response Curve: Myocardial Infarction Meta-Analysis: Road Traffic Noise 5 studies

30 Source: Babisch, 2006, 2008 Exposure-Response Curve: Myocardial Infarction Meta-Analysis: Road Traffic Noise Traffic noise level L day,12hr [dB(A)] Relative risk (odds ratio) Ischaemic Heart Disease Exposure-response function: OR = – *(L day,16h ) *(L day16h ) 3, R 2 = 0.96 OR per 10 dB(A) = 1.17, 95% CI = , range = dB(A) pooled (5 studies)

31 Source: Babisch und van Kamp, 2008 Exposure-response function: OR per 10 dB(A) = 1.13, 95% CI = , range = dB(A) Exposure-Response Curve: Hypertension Meta-Analysis: Aircraft Noise pooled (5 studies) Heterogeneity: p = 0.002

32 Hyena study, 4861 subjects, age yrs Relative prevalence of hypertension by road traffic noise Source: Jarup et al., 2008 Road Traffic Noise - Hypertension "Hyena Study"

33 Hazard identification Exposure-response assessment Exposure assessment Risk characterization Attributable risk concept Risk management Regulatory options Quantitative Risk Assessment Link

34 Annoyance Sleep disturbance (subjective) Cognitive impairment (children) Cardiovascular Established Exposure Response Relationships

35 Population attributable risk Impact fraction AF = { (P i * RR i ) - 1} / (P i * RR i ) where: P i = Proportion of the population in exposure category i RR i = relative risk at exposure category i compared to the reference level Attributable Fraction Formula

36 7-19 year old children Noise exposure level L dn No. of children exposed * % who will develop noise-induced cognitive impairment N with noise-induced cognitive impairment per year < 55 68% % % > 75 2% Total 100% Attributable Fraction: Cognitive Impairment Example: Sweden, Children Source: Hygge, 2009 (presentation in Helsinki) Staffan Hygge * Approximation: European exposure distribution considered for Sweden (Roovers et al., 2000)

37 Moyocardial Infarction (MI) Caused By Traffic Noise Reference year 1999 Average sound pressure level during the day (6-22 h) L day,16hr [dB(A)]* Percentage exposed [%] Relative risk of myocardial infarction [OR] *) <= >60 – >65 – >70 – > Attributable fraction: 2.9% Germany 1999: MI: 133,115 cases IHD: 849,557 cases Attributable Fraction: Myocardial Infarction / IHD Example: Germany, Adults * Probabilistic model Due to road traffic noise: 3,900 MI cases/year 24,700 IHD cases/year MI = Myocardial infarction IHD = Ischaemic heart diseases

38 Source: Babisch, 2002 (WHO modified) Severity vs. Population Affected Mortality Disease (sleep disturbance, cardiovascular) Stress Indicators (autonomous response, stress hormones) Risk factors (blood pressure, cholesterol, blood clotting, glucose) Feelings of discomfort (annoyance, disturbance) Number of people affected

39 Source: de Hollander et al., 2001, 2004 Life expectancy: mortality, morbidity, loss of healthy life- years Quality of life: severe feelings of discomfort, reduced ability to concentrate, unfavourable health perception and stress in relation to poor quality of the local environment Social magnitude:number of people affected DALYs Disability Adjusted Life Years Idea: Quantification Unit One figure to aggregate different effects of different severity

40 Priority setting DALYs as a public health currency? Cost-benefit analysis Monetary valuation of external costs and benefits (DALYs vs. QUALYs) DALY = YLL x YLD YLL = ND (number of deaths) x DW (disability weight) x LD (standard life expectancy at age of death in years) YLD = NI (number of incident cases) x DW (disability weight) x LI (average duration of disability in years) Severity weight factors (disability weights) Ethics (dependent on cultural weighing systems), who decides (experts)? DALYs

41 Mortality = Non-fatal acute myocardial infarction = (WHO) Ischaemic heart disease = (de Hollander, 1999) High blood pressure = (Mathers, 1999) Primary insomnia = (WHO, 2007) Sleep disturbance = (Knol, 2005) ; (Müller-Wenk, 2005) Annoyance = (Stassen, 2008) ; (Müller-Wenk, 2005) Cognitive impairment = (Hygge, 2009) Disability Weights DALYs Disability weights that have been used

42 Noise exposure level L den No. exposed population < 403 % % % > 6024 % Total100 % Attributable Fraction: Annoyance Example: DALYs Per Year For The Netherlands Source: Knol and Staatsen, 2005 Reference year 2000 Exposure distribution ('Empara') Noise sourceDALYs per million people per reference year Road1122 Air16 Rail65 Total1203 "Severe" annoyance ('Miedema' curves) Adults: Disability weight DW = 0.020

43 Example: Severe annoyance Netherlands Severe sleep disturbance Netherlands Cognitive effects Sweden Ischaemic heart diseases Germany SubjectsAdults Children 7-19 yrsAdults Total populationCa. 14 Mio Ca. 1.5 MioCa. 70 Mio ExposureEmpara EU estimateProbabilistic UBA Reference year Disability weight DALYs per Million of people DALY Examples

44 Economic Valuation Example: Switzerland Source: Swiss Federal Office for Spatial Development, 2004, 2008

45 Exposure Assessment Environmental Noise Directive, Noise Mapping Which purpose? -Identification of hot spots (exposure) -Public health (affected population in general) -Action plans -Regulatory (limit values) -Epidemiological study (individual exposure)

46 Shielding: Terraced Houses L day,12 h

47 Distance from the road (meters) Source: Lercher et al. (2000) Exposed Side: High Blood Pressure "Inn Valley Study" Proximity to road, room orientation Proportion with hypertension

48 Source: Lercher et al, 2000 Modifiers of Exposure: Windows "Inn Valley Study" Systolic blood pressure

49 Prospective study, 3950 men, aged yrs Extreme group comparison: L Aeq,day = dB(A) vs dB(A) Relative incidence of major ischaemic heart diseases Source: Babisch et al., Address only + Window orientation + Open window + 15 yrs residence Incidence odds ratio (OR +/- 95% CI) Exposure Misclassification "Caerphilly & Speedwell Studies"

50 Environmental Noise Directive (Directive 2002/49/EG) Phase 1 until »Major road network > 6 Mio vehicles per year »Major railway network > trains per year »Major airports > aircraft movements per year »Major agglomerations > 250,000 inhabitants »Action plans until 2008 Phase 2 until »Major roads > 3 Mio vehicles per year »Major railway tracks > trains per year »Agglomerations > 100,000 inhabitants »Action plans until 2013

51 Augsburg Noise Maps House At A Close Distance To A Major Road City Map ("RLS90")END Map ("VBUS") Software: Cadna

52 Augsburg Noise Maps House At A Close Distance To A Major Road City Map Software: Cadna Front / back side L day, 16h : 70/50 dB(A) Δ = 20 dB(A) END Map Front / back side L day, 12h : 67/44 dB(A) Δ = 23 dB(A)

53 Augsburg Noise Maps House At A Far Distance To A Major Road City MapEND Map Software: Cadna

54 Augsburg Noise Maps House At A Far Distance To A Major Road City Map Software: Cadna Front / back side L day, 16h : 62/46 dB(A) Δ = 16 dB(A) END Map Front / back side L day, 12h : 44/43 dB(A) Δ = 1 dB(A)

55 Exposure-response relationships are available Methods for quantitative risk assessment are established Applicable for general noise policies and action planning ("what happens - if" scenarios) DALYs for combining effects (?) Economic valuation for decision making (?) Exposure assessment must be comprehensive END underestimates the true exposure Conclusions

56 Contact: Calling noise a nuisance is like calling smog an inconvenience (W. H. Steward, former Surgeon General of USA) Thank You For Listening

57 Cardiovascular: L day 65 dB(A) Serious annoyance: L day 55 dB(A) Moderate annoyance: L day 50 dB(A) Cardiovascular: L night 55 dB(A) Sleep disturbance: L night 45/40 dB(A) Outdoors Environmental Noise Quality Targets

58 »Short-term Prevention of health risk L den = 65, L night = 55 »Intermediate Reduction of serious annoyance L den = 60, L night = 50 »Long-term Avoidance of serious annoyance L den = 55, L night = 45 UBA Quality Targets "Federal Environment Agency, Germany"

59 Coherence (biological plausibility) Consistency with other studies in different populations and with different methodology Presence of dose-response relationship Magnitude of effect Even small relative risks may be relevant for public health Epidemiological Reasoning

60 Cross-sectional study, 195 females, aged yrs Overnight excretion of nor-epinephrine in urine by road traffic volume Source: Babisch et al., 2001 Subjects had control over the stimulus Subjects had no control over the noise Coping: Stress Hormones "Berlin Traffic And Health Study"


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