Association Between Long-Term Exposure to Wind Turbine Noise and the Risk of Stroke: Data From the Danish Nurse Cohort

The association of noise exposure with stroke incidence and mortality: A systematic review and dose-response meta-analysis of cohort studies

BACKGROUND AND AIMS

Noise exposure is a major public health challenge with important implications for cardiovascular health. However, the association between noise exposure and stroke risk remains controversial. Therefore, we aimed to evaluate the role of noise exposure on stroke incidence and mortality by conducting a dose-response meta-analysis of cohort studies.

METHODS

The relevant publications were retrieved via PubMed, Embase, Web of Science, and Scopus up to June 26, 2022. The potential linear and curve relationship between noise and stroke were fitted using the generalized least squares method and restricted cubic spline. We estimated the pooled relative risk (RR) with 95% confidence interval (CI) by random-effect models. The Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was used to evaluate the strength of the results.

RESULTS

In total, 21 cohort studies with 16,075,204 participants and 311,878 cases were included in the analysis. The risk of stroke incidence increased up to 4% (95% CI:1.02-1.06) and stroke mortality increased up to 3% (95% CI:1.00-1.07), every 10 dB(A) increment in noise exposure. Moreover, each 10 dB(A) increment in noise exposure was associated with a 4% (95% CI:1.01-1.07) increase in ischemic stroke and a 2% (95% CI:1.00-1.04) increase in hemorrhagic stroke. According to GRADE criteria, the evidence level in this study was rated as moderate.

CONCLUSIONS

The current findings provide further evidence of a dose-response relationship between exposure to noise and the risk of stroke incidence and mortality. Additionally, we update and fill a knowledge gap that the statistically significant increase in stroke incidence when noise decibels are >65 dB(A).

Cerebral consequences of environmental noise exposure

The importance of noise exposure as a major environmental determinant of public health is being increasingly recognized. While in recent years a large body evidence has emerged linking environmental noise exposure mainly to cardiovascular disease, much less is known concerning the adverse health effects of noise on the brain and associated neuropsychiatric outcomes. Despite being a relatively new area of investigation, indeed, mounting research and conclusive evidence demonstrate that exposure to noise, primarily from traffic sources, may affect the central nervous system and brain, thereby contributing to an increased risk of neuropsychiatric disorders such as stroke, dementia and cognitive decline, neurodevelopmental disorders, depression, and anxiety disorder. On a mechanistic level, a significant number of studies suggest the involvement of reactive oxygen species/oxidative stress and inflammatory pathways, among others, to fundamentally drive the adverse brain health effects of noise exposure. This in-depth review on the cerebral consequences of environmental noise exposure aims to contribute to the associated research needs by evaluating current findings from human and animal studies. From a public health perspective, these findings may also help to reinforce efforts promoting adequate mitigation strategies and preventive measures to lower the societal consequences of unhealthy environments.

Health Effects Related to Wind Turbine Sound: An Update

Commissioned by the Swiss Federal Office for the Environment, an update of an earlier narrative review was prepared for the literature published between 2017 and mid-2020 about the effects of wind turbine sound on the health of local residents. Specific attention was hereby given to the health effects of low-frequency sound and infrasound. The Netherlands Institute for Public Health and the Environment and Mundonovo sound research collected the scientific literature on the effect of wind turbines on annoyance, sleep disturbance, cardiovascular disease, and metabolic effects, as well as mental and cognitive impacts. It also investigated what is known about annoyance from visual aspects of wind turbines and other non-acoustic factors, such as the local decision-making process. From the literature study, annoyance again came forward as the most important consequence of sound: the louder the sound (in dB) of wind turbines, the stronger the annoyance response was. The literature did not show that "low-frequency sound" (sound with a low pitch) results in extra annoyance on top of normal sound. Results of scientific research for other health effects are either not available or inconsistent, and we can conclude that a clear association with wind turbine related sound levels cannot be confirmed. There is evidence that long-term effects are related to the annoyance people experience. These results confirm earlier conclusions. There is increasing evidence that annoyance is lower when people can participate in the siting process. Worries of residents should be addressed in an early stage, by involving them in the process of planning and decision making.

Association Between Long-Term Exposure to Wind Turbine Noise and the Risk of Stroke: Data From the Danish Nurse Cohort

Background

Epidemiological studies suggest that road traffic noise increases the risk of stroke. Similar effects may be expected from wind turbine noise (WTN) exposure, but epidemiological evidence is lacking. The present study investigated the association between long‐term exposure to WTN and the risk for stroke.

Methods and Results

First‐ever stroke in 28 731 female nurses in the Danish Nurse Cohort was identified in the Danish National Patient register until the end of 2013. WTN, traffic noise, and air pollution exposures were estimated for all historic and present residential addresses between 1982 and 2013. Time‐varying Cox proportional hazard regression was used to examine the associations between the 11‐, 5‐, and 1‐year rolling means of WTN levels and stroke incidence. Of 23 912 nurses free of stroke at the cohort baseline, 1097 nurses developed stroke by the end of follow‐up. At the cohort baseline, 10.3% of nurses were exposed to WTN (≥1 turbine within a 6000‐meter radius of the residence) and 13.3% in 2013. Mean baseline residential noise levels among exposed nurses were 26.3 dB(A). No association between long‐term WTN exposure and stroke incidence was found. The adjusted hazard ratios and 95% CIs for the 11‐, 5‐, and 1‐year running mean residential WTN exposures preceding stroke diagnosis, comparing nurses with residential WTN levels above and below 20 dB(A) were 1.09 (0.90–1.31), 1.08 (0.89–1.31) and 1.08 (0.89–1.32), respectively.

Conclusions

This comprehensive cohort study lends no support to an association between long‐term WTN exposure and stroke risk.