1. Traffic noise and risk for diabetes and cancer Mette Sørensen Senior researcher, leader of research group Urban Environment Diet, Genes and Environment Danish Cancer Society

2. Traffic noise exposure Stress and sleep disturbance Cardiovascular disease Hypertension Ischemic heart disease Stroke Stockholm, October 2015 Mechanisms, traffic noise Other major diseases?

3. Sleep disturbances Experimental reduction in sleep duration/quality ↓ glucose tolerance, ↑ morning glucose ↓ insulin levels, ↓ insulin sensitivity Epidemiological studies 10 prospective studies, > 100,000 participants, 3500 diabetes cases Reduced sleep quality and quantity increase risk of diabetes Excess of stress hormone (cortisol) ↓ insulin production ↓ insulin sensitivity Sleep disturbance, stress and diabetes Stockholm, October 2015

4. Study population Diet, Cancer and Health cohort Enrolment in 1993-1997 57,053 persons aged 50-64 years Copenhagen and Aarhus Questionnaire (diet, smoking, alcohol, education etc.) Weight, height and waist circumference measured → Central Population Registry: all residential addresses 1987-2010 → The National Diabetes Registry: 3,869 diabetes cases Stockholm, October 2015

5. Noise exposure SoundPLAN – the Nordic Prediction Method Geographical coordinates for each address Height (floor) for each address Building polygons All road lines with > 1000 vehicles Traffic composition (heavy/light) Yearly average daily traffic Traffic speed AirGIS – model for estimation of air pollution Stockholm, October 2015

6. Results, diabetes Road traffic noise L den, per 10 dB Cases Adjusted IRR (95% CI) All diabetes, 5-years3 8691.11 (1.05-1.18) Confirmed diabetes*, 5 years2 7521.14 (1.06-1.22) *Excluded cases only included in Diabetes Registry based on blood glucose tests Stockholm, October 2015 Exposure-response relationship

7. Calculations for Denmark 5.5 million inhabitants The risk estimates of our study Distribution of road traffic noise in Denmark (report Danish EPA) 1,400 new diabetes cases every year How many extra diabetes cases due to road traffic noise? Stockholm, October 2015

8. Eriksson et al 2014, Stockholm Arlanda airport 5,156 participants Pre-diabetes: 412 (52 ≥ 50 dB) Diabetes: 159 (26 ≥ 50 dB) Overall no associations between airport noise and diabetes Suggestions of association with diabetes (but not pre-diabetes) in women (1.27 (0.94-1.71) per 5 dB increase) No associations in men Noise and diabetes, other studies Stockholm, October 2015

9. Stress, sleep and breast cancer Stockholm, October 2015 Sleep disturbance Short sleep duration may suppress melatonin Melatonin: body's circadian rhythm anti-carcinogenic Night work associated with breast cancer Self-reported sleep maybe associated with breast cancer Stress - glucocorticoids Suspected of promoting tumor growth

10. Study, breast cancer Stockholm, October 2015 Study population, 30,000 women Residential addresses 1987-2010 Danish Cancer Registry -> 1,219 cases Danish Breast Cancer Co-operative group: Estrogen receptor: 858 positive/203 negative cases Adjustment: Parity, age first birth, HRT, lifestyle, SES

11. Results, breast cancer Stockholm, October 2015 Traffic noise, per 10 dB Cases Adjusted IRR (95% CI) Road traffic noise, 5-years ER positive8580.99 (0.89-1.10) ER negative203 1.23 (1.00-1.51) Railway noise, diagnosis ER positive858 0.96 (0.83-1.26) ER negative203 1.38 (1.01-1.89)

12. Non-Hodgkin’s lymphoma (NHL) originating from lymphoid tissue incidence rates increased since 1960 etiology largely unknown well-established risk factor is suppression of immune system HIV patients immunosuppressive drugs Nordic age-adjusted NHL incidence rates (per 100,000) Stockholm, October 2015

13. Stress, sleep and NHL Sleep disturbance Sleep deprivation associated with immune system impairment sleep restriction at night after vaccination: ↓ antibody conc. ↑ pro-inflammatory molecules ↓ immuno-stimulating hormones Epi studies indicate night-shift workers at higher NHL risk Stress Acute and chronic stressors, e.g. exams and stressful life events associated with impaired immune system Stockholm, October 2015

14. NHL, design and results Traffic noise Cases Adjusted OR (95% CI) Road traffic noise, 5-y < 55 dB 1,1031.00 55-65 dB 1,2560.98 (0.88-1.08) ≥ 65 dB3941.18 (1.01-1.37) National register-based case-control study 2,753 cases / 4,743 controls Adjusted for sex, age and SES Stockholm, October 2015

15. Conclusions DIABETES Road traffic noise associated with higher risk for diabetes Aircraft noise possibly associated with diabetes in women; not in men (and not with pre-diabetes) CANCER Road traffic AND railway noise associated with higher risk for ER- breast cancer Road traffic noise associated with higher risk for NHL OVERALL CONCLUSION Although more studies are needed, research suggests that traffic noise is associated with other major diseases than cardiovascular