Exposure-response relationship between transportation noise and cardiovascular disease outcomes: a systematic review and meta-regression analysis

BACKGROUND: Current risk assessments of cardiovascular disease (CVD) outcomes attributable to transportation noise rely on estimates from the 2018 WHO Environmental Noise Guidelines. Since the publication of these guidelines, several studies have been conducted to determine the association between transportation noise sources and CVD; however, recent meta-analyses have not derived updated exposure-response functions. OBJECTIVE: We reviewed epidemiological evidence linking long-term exposure to road traffic, railway, and aircraft noise with non-fatal and fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke, and derived exposure-response functions using the conventional and Burden of Proof (BoP) methodologies. METHODS: We systematically searched databases for cohort or case-control studies that determined the associations between non-fatal and/or fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke and long-term exposure to road traffic, railway, aircraft noise in general populations. Exposure-response functions were generated using the conventional natural cubic splines and Burden of Proof Risk Function approaches. RESULTS: Twenty-six studies met our eligibility criteria. Road traffic noise was associated with 1% increase in the combined risk of stroke incidence and mortality (RR = 1.01, 95%CI: 1.00-1.02, p-value = 0.04), and with 5% increase under the BoP framework (RR = 1.05, 95%UI: 1.03-1.07). Railway noise was associated with 1% increase in myocardial infarction outcomes (RR = 1.01, 95%CI: 1.01-1.01, p-value < 0.0001), and with 16% increase under the BoP framework (RR = 1.16 95%UI: 1.07-1.26). Of the twelve risk-outcome pairs examined, five showed no evidence of association, four showed weak evidence, and the remainder lacked credible evidence or did not meet the BoP criteria. Compared with the natural splines approach, the BoP framework produced more plausible exposure-response curves. SIGNIFICANCE: This study adds to the existing literature by providing a comprehensive comparison of the association between long-term exposure to transportation noise sources and CVD outcomes using both conventional and BoP methodologies. IMPACT STATEMENT: This is the first study to apply the conventional meta-regression and Burden of Proof methodologies to systematically quantify and evaluate associations between long-term exposure to transportation noise sources (i.e., road traffic, railway, and aircraft) and combined risk of fatal and non-fatal cardiovascular disease outcomes, including myocardial infarction, ischemic heart disease, stroke, and ischemic stroke. The application of these two approaches to deriving exposure-response functions provides additional insights into the quantification of the burden of disease attributable to transportation noise. Our findings using the Burden of Proof framework on transportation noise and CVD outcomes advance the integration of an additional environmental risk factor and propose new risk-outcome pairs for potential inclusion in the Global Burden of Disease study.