Table 1.

Estimation of the effects of exposure to noise levels on cardiovascular mortality and morbidity while controlling for air pollution (Sweden [1992–1994], Denmark [1993–2006], Canada [1994–2002], Switzerland [2002–2003], Netherlands [1997–1998] and, [1987–1996])

Studies		Characteristics of the studya	Traffic noise exposure (noise indicator) [validation of the model]	Air pollution exposure (air pollution indicator) [validation of the model]	Exposure levels	Health outcome (definition)	Main findings: (95 % confidence interval)	Percentage of change in the estimate
de Kluizenaar et al. (2007)	Groningen sample:	Cross-sectional N: 40,856 28–75 years Groningen, Netherlands 1997–1998	Dispersion model : The Standaart Kartering Method 2 implemented in Urbis (L den) [no information on validation]	Dispersion models:  (i) Local traffic contribution from the model CAR II  (ii) The Gaussian dispersion model “Pluim” (PM10) [no information on validation]	Average (SD) L den in the Groningen sample: No AHT: 53.3 (6.9) dB(A) AHT: 54.6 (7.0) dB(A) Median (5–95 percentile) PM10 level in the Groningen sample: No AHT: 33.5 (32.8–37.5) μg/m3 AHT: 33.6 (32.9–37.6) μg/m3	Self-reported antihypertensive medication intake	OR per 10 dB(A) increase  Full sample   ORA 1.01 (0.96–1.06)   ORP 1.03 (0.96–1.11)  Subgroup 45–55 years   ORA 1.08 (0.97–1.20)   ORP 1.19 (1.02–1.40)	Full sample 1.98 % Subgroup 45–55 years 10.19 %
	PREVENT cohort sub sample	Cross-sectional N: 8,592 28–75 years Groningen, Netherlands 1997–1998				Hypertension: use of antihypertensive medication (pharmacy record) or systolic blood pressure ≥140 and diastolic blood pressure ≥90 (mean of the last 2 measurements from the 2 visits)	OR per 10 dB(A) increase  Full sample   ORA 1.07 (0.98–1.18)   ORP 1.08 (0.95–1.23)  Subgroup 45–55 years   ORA 1.27 (1.08–1.49)   ORP 1.39 (1.08–1.77)	Full sample 0.93 % Subgroup 45–55 years 9.45 %
Beelen et al. (2009)		Cohort N: 117,528 55–69 years Netherlands 1987–1996	Dispersion model :Empara (L den) [Measured vs. Estimated: on average <2–3 dB(A)]	Land use regression (black smoke) [R 2 = 0.59]	Average L den level (SD) : 52 (7) dB(A) Black smoke average level: 13.9 (2.2) μg/m³ NO2 average level: 30 mg/m3	Mortality from: ischemic heart disease, cardiovascular disease, cerebrovascular disease, heart failure and cardiac dysrhythmia (ICD 9 for 1986–1995 and ICD 10 for 1996)	RR compared to a reference category of ≤50 dB(A)  Overall cardiovascular mortality   RRA 1.25 (1.01–1.53)   RRP 1.17 (0.94–1.45)  Ischemic heart disease mortality   RRA 1.15 (0.86–1.53)   RRP 1.01 (0.74–1.36)  Cerebrovascular mortality   RRA 0.88 (0.52–1.50)   RRP 0.95 (0.55–1.66)  Heart failure mortality   RRA 1.99 (1.05–3.79)   RRP 1.90 (0.96–3.78)  Cardiac dysrhythmia mortality   RRA 1.23 (0.50–3.01)   RRP 1.23 (0.48–3.13)	Overall cardiovascular mortality 6.40 % Ischemic heart disease mortality 12.17 % Cerebrovascular mortality 7.95 % Heart failure mortality 4.52 % Cardiac dysrhythmia mortality 0.00 %
Selander et al. (2009)		Case–control N: 2,095 (controls) + 1,571 (cases) 45–70 years Stockholm country, Sweden 1992–1994	Dispersion model: simplified Nordic prediction method (L A,eq,24h) [No information on validation]	Dispersion model: Gaussian Air Quality Dispersion model (NO2) [No information on validation]	L A,eq,24h: NA NO2: median level 12.9 μg/m3 for controls Median level for cases: NA	Myocardial infarction (coronary records, hospital discharge register and the National Cause of Death at statistic Sweden)	OR compared to a reference category of ≤50 dB  Full sample   ORP 1.12 (0.95–1.33)	7 %
Sorensen et al. (2011)		Cohort N: 51,485 55–64 years Copenhagen or Aarthus, Denmark 1993–2006	Dispersion model: Sound plan with the Nordic prediction method, DANSIM and INM 3 (L den) [Measured vs. Estimated: on average 0.2 dB]	Dispersion model: Danish AirGis (NOX) [R 2 = 0.75]	Median L den (5–95 percentile) : <64.5 years 57.8 (NA) dB(A) and ≥64.5 years 58.2 (NA) dB(A) NOX 5–95 percentile) median levels at L den ≤60 dB 18.5 (14.1–28.3) μg/m3 and L den >60 dB 34.3 (16.9–137) μg/m3	Stroke (hospital discharge register ICD 8 and 10)	IRR per 10 dB(A) increase  Full sample   IRRA 1.10 (1.03–1.18)   IRRP 1.14 (1.03–1.25)	3.64 %
Sorensen et al. (2012a)		Cohort N: 50,614 55–64 years Copenhagen or Aarthus, Denmark 1993–2006	Dispersion model: Sound plan with the Nordic prediction method, DANSIM and INM 3 (L den) [Measured vs. Estimated: on average 0.2 dB]	Dispersion model: Danish AirGis (NOX) [R 2 = 0.75]	Median L den (5–95 percentile) 56.4 (48.5–70.1) dB(A) Median NOX (5–95 percentile) 20.8 (14.4–88.0) μg/m3	Myocardial infarction (ICD 10)	IRR per 10 dB(A) increase  Full sample (per 10 dB[A])   IRRcrude 1.10 (1.03–1.19)   IRRAdj 1.12 (1.02–1.22)	1.82 %
Gan et al. (2012)		Cohort N: 445,868 45–85 years Vancouver Canada 1994–2002	Dispersion model: CadnaA base model using the EMME/2 for traffic volume (L den) [No information on validation]	Land use regression (NO2, PM2.5 and black carbon) [NO2: R 2 = 0.56 PM2.5 R 2 = 0.52 Black carbon NA]	Average L den (SD): 63.4 (5.0) dB(A) PM2.5 average level (SD): 4.10 (1.64) μg/m3 NO2 average level (SD): 32.3 (8.1) μg/m3 NOX average level (SD): 32.2 (12.0) μg/m3 Black carbon average level (SD): 1.50 (1.1) 10−5/m	Ischemic heart diseases mortalities (ICD-9 and ICD-10)	RR per increase of 10 dB(A)  PM2.5   RRA 1.13 (1.06–1.21)   RR P 1.13 (1.06–1.21)  NO2 + PM2.5   RRA 1.13 (1.06–1.21)   RR P 1.12 (1.05–1.21)  Black carbon + NO2 + PM2.5   RRA 1.13 (1.06–1.21)   RR P 1.09 (1.01–1.18)	PM2.5 0.00 % NO2 + PM2.5 0.88 % Black carbon + NO2 + PM2.5 3.54 %
Dratva et al. (2012)		Cross-sectional N: 6,450 28–72 years Switzerland 2002–2003	Dispersion model: SONABASE (L Day and L night) [Measured vs. Estimated: on average ± 2.6 dB(A) (day) ± 3.1 dB(A) (night)]	Dispersion model: PolluMap Gaussian dispersion model (NO2) [R 2 = 0.72]	Average (SD) L day : 50.5 (7.2) dB(A) Average (SD) L night : 38.7 (7.8) dB(A) Average (SD) levels for: NO2: 23.0 (9.9) μg/m3 PM10: 21.3 (7.1) μg/m3	Blood pressure (measured by the Riva-Rocci method by trained field workers)	Increase in BP per 10 dB (A)  Night time systolic BP  β A: −0.01 (−0.6 to 0.59)  β AP: 0.15 (−0.48 to 0.77)  Nighttime diastolic BP   β A: −0.05 (−0.41 to 0.30)   β AP: −0.15 (−0.36 to 0.39) Daytime systolic BP  β A: −0.11 (−0.68 to 0.47)  β AP: 0.05 (−0.56 to 0.07) Daytime diastolic BP  β A: −0.10 (−0.44 to 0.24)  β AP: −0.04 (−0.40 to 0.33)	Nighttime systolic BP 1,600 % Nighttime diastolic BP 200 % Daytime systolic BP 145.45 % Daytime diastolic BP 60 %

^a Final sample sizes used for analysis

OR odds ratio, NA not available, IRR incident rate ratio, RR risk ratio, A adjusted for some of the following potential confounding factors: age, education, employment, marital status, study area, mean pulse, hearing impairment, noise at work, crowding, home ownership, mother’s educational level, language spoken at home, parental support for schoolwork, classroom window glazing, body mass index, cuff size, room temperature, birth weight, parental high blood pressure, prematurity, smoking status, family history of CVD, physical inactivity smoking intensity, intake of fruits, intake of vegetables, intake of coffee, alcohol intake diabetes, antihypertensive medication, high blood pressure, long-standing illness and other comorbidity (see original article for details), P adjusted for some potential confounding factors and air pollution levels, AHT antihypertensive treatment, SD standard deviation, β regression coefficient, PM _2.5 particles with a diameter of 2.5 μm or smaller, PM ₁₀ particles with a diameter of larger than 2.5 μm, but smaller than 10 μm, NO ₂ Nitrogen dioxide, NO _X Nitrogen oxide, dB(A) A-weighted decibels, L _day integrated A-weighted sound level over 16 h (0600–2200), L _night integrated A-weighted sound level over 8 h (2200–0600), L _A,eq,24h integrated A-weighted sound level over 24 h, L _den integrated A-weighted sound level over 24 h (day, evening and night) in which sound levels during the evening (1900–2300 hours) are increased by 5 dB(A) and those during the night (2300–0700 hours) by 10 dB(A)