Aircraft noise and cardiovascular disease near Heathrow airport in London: small area studyBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5432 (Published 08 October 2013) Cite this as: BMJ 2013;347:f5432
- Anna L Hansell, assistant director1, honorary consultant2,
- Marta Blangiardo, non-clinical lecturer in biostatistics1,
- Lea Fortunato, research associate1,
- Sarah Floud, PhD student1,
- Kees de Hoogh, senior research officer1,
- Daniela Fecht, research associate1,
- Rebecca E Ghosh, research associate1,
- Helga E Laszlo, acoustician1,
- Clare Pearson, research assistant1,
- Linda Beale, honorary research fellow1,
- Sean Beevers, senior lecturer in air quality modelling3,
- John Gulliver, lecturer in environmental science1,
- Nicky Best, professor in statistics and epidemiology1,
- Sylvia Richardson, visiting professor in biostatistics1, director4,
- Paul Elliott, director1
- 1UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Dept Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, UK
- 2Imperial College Healthcare NHS Trust, London, UK
- 3Environmental Research Group, MRC-PHE Centre for Environment and Health, King’s College London, UK
- 4MRC Biostatistics Unit, Cambridge, UK
- Correspondence to: P Elliott
- Accepted 16 August 2013
Objective To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population.
Design Small area study.
Setting 12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London.
Population About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants).
Main outcome measures Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05.
Results Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, LAeq,16h) and night time (11 pm to 7 am, Lnight) aircraft noise. When areas experiencing the highest levels of daytime aircraft noise were compared with those experiencing the lowest levels (>63 dB v ≤51 dB), the relative risk of hospital admissions for stroke was 1.24 (95% confidence interval 1.08 to 1.43), for coronary heart disease was 1.21 (1.12 to 1.31), and for cardiovascular disease was 1.14 (1.08 to 1.20) adjusted for age, sex, ethnicity, deprivation, and a smoking proxy (lung cancer mortality) using a Poisson regression model including a random effect term to account for residual heterogeneity. Corresponding relative risks for mortality were of similar magnitude, although with wider confidence limits. Admissions for coronary heart disease and cardiovascular disease were particularly affected by adjustment for South Asian ethnicity, which needs to be considered in interpretation. All results were robust to adjustment for particulate matter (PM10) air pollution, and road traffic noise, possible for London boroughs (population about 2.6 million). We could not distinguish between the effects of daytime or night time noise as these measures were highly correlated.
Conclusion High levels of aircraft noise were associated with increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality in areas near Heathrow airport in London. As well as the possibility of causal associations, alternative explanations such as residual confounding and potential for ecological bias should be considered.
We dedicate this paper to Lars Jarup who helped initiate this project and passed away in 2010. We thank Peter Hambly, Margaret Douglass, Eric Johnson, Kayoung Lee, and David Morley for technical support and the advisory group members: Tim Williams, Yvette Bosworth (Defra), Stephen Turner (Bureau Veritas/Defra), and Nigel Jones (Extrium) who provided traffic noise data, and Darren Rhodes and Kay Jones (Civil Aviation Authority) who provided aircraft noise data.
Contributors: PE and ALH with MB, LF, SF, KdH, DF, LB, and SR conceived and designed the study. MB, LF, SF, KdH, DF, REG, LB, JG, and SB were involved in data extraction and preparation. JG, KdH, and DF were responsible for the Geographical Information System analyses. JG, KdH, and HEL interpreted the aircraft noise data. LF and MB with REG and CP carried out the statistical analyses, supervised by PE, ALH, SR, and NB. The analyses were interpreted by PE, ALH, MB, LF, NB, SR, HEL, and JG. ALH and PE drafted the initial report; all coauthors revised the report and approved the final version. MB and LF contributed equally to this paper and are joint second authors. PE is the guarantor of this paper.
Funding: The work of the UK Small Area Health Statistics Unit is funded by Public Health England as part of the MRC-PHE Centre for Environment and Health, funded also by the UK Medical Research Council. Support was received from the European Network for Noise and Health (ENNAH), EU FP7 grant No 226442. PE acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College Healthcare NHS Trust and Imperial College London. PE is an NIHR senior investigator. The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the article; and in the decision to submit the article for publication. The advisory group provided advice on methodology but was not involved in the analyses, interpretation of results, or writing of the paper. The views expressed are those of the authors and not necessarily those of the NHS, NIHR, or Department of Health.
Competing interests: All authors have completed the ICMJE uniform disclosure at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: financial support for the submitted work through the funding of the UK Small Area Health Statistics Unit by Public Health England as part of the MRC-PHE Centre for Environment and Health, funded also by the UK Medical Research Council; financial support from the European Network for Noise and Health (ENNAH), EU FP7 grant No 226442; PE acknowledges support from the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London; PE is an NIHR Senior Investigator; ALH and HEL declare consultancy fees from AECOM as part of a Defra report on health effects of environmental noise; ALH declares a Greenpeace membership but has not received any money from the organisation nor been involved in campaigns; nor other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: The study was commissioned by the Department of Health in England; ethical approval was obtained from the National Research Ethics Service reference 12/LO/0566 and the Imperial College Research Ethics Committee.
Data sharing: Data are available from the data providers on application with appropriate ethics and governance permissions, but we do not hold data provider, ethics, or governance permissions to share the dataset with third parties.
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