**5. Health outcomes of the noise exposure**

Exposure to noise can lead to auditory and nonauditory effects on health. Through direct injury to the auditory system, noise exerts auditory effects such as hearing loss and tinnitus. Noise is also a nonspecific stressor that has been shown to have an adverse effect on human health, especially following long-term exposure. These effects are the result of psychological and physiological distress, as well as disturbing homeostasis of an organism and increasing allostatic load [13].

The most common noise-related health effect is annoyance. Noise annoyance is caused by noise-related disturbances of the individual's speech communication, concentration, and performance of tasks, and it is commonly associated with negative emotional reactions, such as feelings of displeasure, anger, and disappointment. Furthermore, annoyance may give rise to physiological symptoms, including tiredness, stomachache, and stress symptoms. In fact, noise annoyance is a symptom of stress building up inside as a consequence of signals transmitted from the auditory system to the nervous system, stimulating several subsequent reactions in our bodies [14].

Since endocrine changes manifesting physiological disorders come first in the chain of cause effect for perceived noise stress, noise effects on stress hormones may therefore be detected in populations after relatively short periods of noise exposure. This makes stress hormones a useful stress indicator but in terms of the risk assessment, usually the quantitative interpretation of endocrine noise effects is often a quantitative one rather than quantitative one. The most well-known mechanism mediating the response to stress is the hypothalamic-pituitary-adrenal (HPA) axis. When the HPA axis receives a signal of a stress response, corticotropin-releasing factor is secreted from the hypothalamus, which in response releases adrenocorticotropic hormone from the pituitary gland. Adrenocorticotropic hormone then promotes the secretion of cortisol from the adrenal cortex through the blood, which triggers responses to various kinds of stress. The secretion of cortisol in response to stress inhibits the function of the HPA axis to disrupt the secretion of neurohormones and neurotransmitters as well as influencing the endocrine system, thereby disturbing homeostasis of the body, which can induce the development of various stress-related diseases [15]. Recent studies have also reported that sleep quality and noise sensitivity are not related to vascular function, but rather that night noise increases the risk of cardiovascular disease due to the increased blood pressure [7].

The associations between noise and health could be modified by several factors (effect modifiers), so individuals may therefore be more or less affected by the noise. These so-called "effect modifiers" can be demographic factors, for instance, age, sex, and socioeconomic position; personal or attitudinal factors, such as noise sensitivity and fear of the noise source; or related to the individual lifestyle and occupation, including physical activity, psychosocial health, and job strain. In addition, coping mechanisms, such as use of ear plugs or window opening behavior, and situational factors, including time of day and type of activity, may modify the effect of exposure (**Figure 2**) [16]. Identification of risk groups, individuals who are particularly vulnerable to noise, is important for assessments of public health impact and can serve as a basis for preventive measures. For each specific health outcome, one should consider not only the available factors that may modify the effect of noise but also the annoyance rating of noise sensitivity as the most important individual characteristic when predicting dissatisfaction with the noise [14, 17].

The health outcomes influenced by possible nonacoustic factors may include gender, age, education, subjective noise sensitivity, extroversion/introversion, general stress score, comorbidity, length of residence, duration of stay at dwelling in the day, window orientation of a bedroom or living room toward the street, personal evaluation of the source, attitudes toward the noise source, coping capacity with respect to noise, perception of malfeasance by the authorities responsible,

**29**

*Neighborhood Noise*

**Figure 2.**

*DOI: http://dx.doi.org/10.5772/intechopen.92877*

body mass index, and smoking habits. In noise annoyance studies, nonacoustic

According to WHO report, the key health outcomes associated with environmental noise exposure based on the seriousness and prevalence and the anticipated availability of evidence were in the following. The health outcomes were divided as either critical or important for developing recommendations on the health impacts of environmental noise. The selection of health outcomes was based on the available evidence for the association between the environmental noise and the specific outcome, as well as public concern about the health outcome resulting from noise exposure. The critical health outcomes associated with environmental noise included such as cardiovascular disease, annoyance, sleep disturbance, cognitive impairment, and hearing impairment and tinnitus. In addition, the important health outcomes were adverse birth outcomes, metabolic outcomes, quality of life,

*The framework of health effects of noise according to environmental noise and health – current knowledge and* 

The following health outcomes were based on the evidence-based association between the environmental noise and the specific outcome, as well as public concern about the health outcome resulting from noise exposure. These health outcomes can be measured in various ways, and their prioritization was based on the impact of the disease and the disability weights (DWs) associated with the health outcome measure. A disability weight is a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (equivalent to death). Years Lost due to Disability (YLD) are calculated by multiplying the incident cases by duration and disability weight for the health condition [8]. In case of cardiovascular disease, DW of IHD is 0.405, DW of hypertension is 0.117, and the severity of the disease itself is high in IHD. However, the incidence rate varies depending on the survey area or country, the results of YLD may be different. The critical health outcomes, identification of the priority outcome measures, and justifications for their selec-

factors may explain up to 33% of the variance [18].

well-being, and mental health [19].

*research needs ISBN 978-91-620-6553-9.*

tions are listed in **Table 5** [19].

#### **Figure 2.**

*Noise and Environment*

bodies [14].

the increased blood pressure [7].

with the noise [14, 17].

hearing loss and tinnitus. Noise is also a nonspecific stressor that has been shown to have an adverse effect on human health, especially following long-term exposure. These effects are the result of psychological and physiological distress, as well as disturbing homeostasis of an organism and increasing allostatic load [13].

The most common noise-related health effect is annoyance. Noise annoyance is caused by noise-related disturbances of the individual's speech communication, concentration, and performance of tasks, and it is commonly associated with negative emotional reactions, such as feelings of displeasure, anger, and disappointment. Furthermore, annoyance may give rise to physiological symptoms, including tiredness, stomachache, and stress symptoms. In fact, noise annoyance is a symptom of stress building up inside as a consequence of signals transmitted from the auditory system to the nervous system, stimulating several subsequent reactions in our

Since endocrine changes manifesting physiological disorders come first in the chain of cause effect for perceived noise stress, noise effects on stress hormones may therefore be detected in populations after relatively short periods of noise exposure. This makes stress hormones a useful stress indicator but in terms of the risk assessment, usually the quantitative interpretation of endocrine noise effects is often a quantitative one rather than quantitative one. The most well-known mechanism mediating the response to stress is the hypothalamic-pituitary-adrenal (HPA) axis. When the HPA axis receives a signal of a stress response, corticotropin-releasing factor is secreted from the hypothalamus, which in response releases adrenocorticotropic hormone from the pituitary gland. Adrenocorticotropic hormone then promotes the secretion of cortisol from the adrenal cortex through the blood, which triggers responses to various kinds of stress. The secretion of cortisol in response to stress inhibits the function of the HPA axis to disrupt the secretion of neurohormones and neurotransmitters as well as influencing the endocrine system, thereby disturbing homeostasis of the body, which can induce the development of various stress-related diseases [15]. Recent studies have also reported that sleep quality and noise sensitivity are not related to vascular function, but rather that night noise increases the risk of cardiovascular disease due to

The associations between noise and health could be modified by several factors (effect modifiers), so individuals may therefore be more or less affected by the noise. These so-called "effect modifiers" can be demographic factors, for instance, age, sex, and socioeconomic position; personal or attitudinal factors, such as noise sensitivity and fear of the noise source; or related to the individual lifestyle and occupation, including physical activity, psychosocial health, and job strain. In addition, coping mechanisms, such as use of ear plugs or window opening behavior, and situational factors, including time of day and type of activity, may modify the effect of exposure (**Figure 2**) [16]. Identification of risk groups, individuals who are particularly vulnerable to noise, is important for assessments of public health impact and can serve as a basis for preventive measures. For each specific health outcome, one should consider not only the available factors that may modify the effect of noise but also the annoyance rating of noise sensitivity as the most important individual characteristic when predicting dissatisfaction

The health outcomes influenced by possible nonacoustic factors may include gender, age, education, subjective noise sensitivity, extroversion/introversion, general stress score, comorbidity, length of residence, duration of stay at dwelling in the day, window orientation of a bedroom or living room toward the street, personal evaluation of the source, attitudes toward the noise source, coping capacity with respect to noise, perception of malfeasance by the authorities responsible,

**28**

*The framework of health effects of noise according to environmental noise and health – current knowledge and research needs ISBN 978-91-620-6553-9.*

body mass index, and smoking habits. In noise annoyance studies, nonacoustic factors may explain up to 33% of the variance [18].

According to WHO report, the key health outcomes associated with environmental noise exposure based on the seriousness and prevalence and the anticipated availability of evidence were in the following. The health outcomes were divided as either critical or important for developing recommendations on the health impacts of environmental noise. The selection of health outcomes was based on the available evidence for the association between the environmental noise and the specific outcome, as well as public concern about the health outcome resulting from noise exposure. The critical health outcomes associated with environmental noise included such as cardiovascular disease, annoyance, sleep disturbance, cognitive impairment, and hearing impairment and tinnitus. In addition, the important health outcomes were adverse birth outcomes, metabolic outcomes, quality of life, well-being, and mental health [19].

The following health outcomes were based on the evidence-based association between the environmental noise and the specific outcome, as well as public concern about the health outcome resulting from noise exposure. These health outcomes can be measured in various ways, and their prioritization was based on the impact of the disease and the disability weights (DWs) associated with the health outcome measure. A disability weight is a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (equivalent to death). Years Lost due to Disability (YLD) are calculated by multiplying the incident cases by duration and disability weight for the health condition [8]. In case of cardiovascular disease, DW of IHD is 0.405, DW of hypertension is 0.117, and the severity of the disease itself is high in IHD. However, the incidence rate varies depending on the survey area or country, the results of YLD may be different. The critical health outcomes, identification of the priority outcome measures, and justifications for their selections are listed in **Table 5** [19].


*DW: A disability weight is a weight factor that reflects the severity of the disease on a scale from 0 (perfect health) to 1 (equivalent to death).*

#### **Table 5.**

*Critical health outcomes, outcome measures identified, and justifications for selection according to the WHO Environmental Noise Guidelines for the European Region.*

**31**

**Table 7.**

*Guidelines for the European Region.*

*Neighborhood Noise*

**with DW)**

**Table 6.**

*DOI: http://dx.doi.org/10.5772/intechopen.92877*

**Priority health outcome measure (associated** 

*Environmental Noise Guidelines for the European Region.*

Quality of life, well-being, and mental

health (*L*den)

**6. The burden of environmental noise and adverse health outcome**

measures. DWs are ratings that vary between 0 and 1, in which 0 indicates no disability and 1 indicates the maximum amount of disability. The DWs have been

Permanent hearing impairment (DW: 0.0150) No risk increase due to environmental noise Reading and oral comprehension (DW: 0.006) One-month delay in terms of reading age

*Priority health outcomes and relevant risk increases for setting guideline levels according to the WHO* 

• Low birth weight • Congenital anomalies

• Children's hyperactivity • Other mental health outcomes

Metabolic outcomes (*L*den) Prevalence, incidence, hospital admission, or mortality due to: • type 2 diabetes • obesity

• Self-reported health and quality of life • Medication intake for depression and anxiety

• Emotional and conduct disorders in children

• Self-reported depression, anxiety, and psychological distress • Interviewer-assessed depressive and anxiety disorders

**Important health outcome Health outcome measures reviewed**

Adverse birth outcomes (*L*den) • Pre-term delivery

For cardiovascular disease, the DW value (DW: 0.405) specifically applied to acute myocardial infarction in the publication outlining the data sources, 5% increase of relative risk in ischemic heart disease (IHD) and 10% in hypertension. The DWs for high sleep disturbance (DW: 0.07), high annoyance (DW: 0.02), and impaired reading and oral comprehension (DW: 0.006) were developed in the context of calculating the burden of disease from environmental noise. According to the WHO night noise guidelines, there were observed adverse health effects at levels starting from 40 dB *L*night, and self-reported sleep disturbance (HSD) and

*Important health outcomes and health outcome measures reviewed according to the WHO Environmental Noise* 

proven useful in calculating the burden of disease (**Table 6**).

Incidence of IHD (DW: 0.405) 5% RR increase Incidence of hypertension (DW: 0.117) 10% RR increase %HA (DW: 0.02) 10% absolute risk %HSD (DW: 0.07) 3% absolute risk

The disability weight (DW) is used to rank the priority critical health outcome

**guideline level**

**Relevant risk increase considered for setting of** 
