There have been a long series of scientific studies of effects of chronic (i.e. repeated) aircraft noise pollution on human physical and mental health. Below these are listed separately, in some articles both are discussed.

In the literature the effects of aircraft noise pollution are often described as being ‘annoying’ or ‘highly annoying’, sometimes as anger making. However, there are two aspects to its impacts. It is important at the outset to clearly distinguish between these two very different aspects of noise pollution, from whatever source. These are: i) personal annoyance and ii) clinical effects:

  • Personal Annoyance: New and repeated loud noises are commonly annoying, the louder and more frequent the noise the more annoying. However, humans quite quickly habituate or adapt and noises quite quickly become less noticeable, even though they continue unabated.
  • Clinical Effects: These occur regardless of whether a person finds loud noises annoying. They have physical and psychological (psychosomatic) effects even if we are not aware of them, i.e. we have habituated. Chronic continuous or repeated exposure leads to more progressively severe and lasting long-term effects; it is not clear if the effects of chronic exposure is linear or exponential.

This distinction is important to keep in mind when responding to or discussing the longer-term effects of aircraft noise pollution – the clinical effects, e.g. on cardiac disease, continue even when people no longer notice or are annoyed by the noise.

The studies are listed in reverse chronological order, newest first; the lead author’s name and date of publication are noted in parenthesis for ease of referencing. Some of the abstracts are rather technical, but the basic finding always seem clear. New studies that are found, or others can referred, will be added as available. The title and abstract (where available) for each article are listed. Copies of almost all the articles listed are available in PDF.

Aviation Noise Impacts White Paper – State of the Science 2019[1]

  1. Sparrow, T. Gjestland, R. Guski, I. Richard, M. Basner, A. Hansell, Y. de Kluizenaar,
  2. Clark, S. Janssen, V. Mestre, A. Loubeau, A. Bristow, S. Thanos, M. Vigeant, R. Cointin.

(Sparrow 2019)


This paper provides an overview of the state of the science regarding aviation noise impacts as of early 2019. It contains information on impacts including community noise annoyance, sleep disturbance, health impacts, children’s learning, helicopter noise, supersonic aircraft, urban air mobility and unmanned aerial systems. The paper also considers the economic costs of aviation noise. This information was collected during an ICAO/CAEP Aviation Noise Impacts Workshop in November 2017 and in subsequent follow-on discussions.

Health Impacts There is good biological plausibility for health impacts of environmental noise, with potential mechanisms involving sleep disturbance, ‘fight and flight’ physiological response and annoyance. he number of epidemiological studies investigating impacts of environmental noise on disease risk and risk factors has increased greatly since the previous ICAO white paper and these have been used to define exposure-response relationships. Some variability is expected between epidemiological studies due to differences in populations, methodology, exposures and study design. Therefore, a combined estimate from a meta-analysis of studies with a low risk of bias is used to provide a state of the art estimate of the exposure response relationship.

Conclusions: There has been a large increase in studies in recent yearsexamining associations of noise exposure with health outcomes. The best epidemiological evidence relates to cardiovascular disease, which includes analyses from populationbased studies covering millions of individuals, in particular for new cases of ischaemic heart disease. Findings for aircraft noise are consistent with those for road traffic noise (for which more studies have been conducted and where the quality of evidence is rated as high). Results from epidemiological studies are also supported by evidence from human and animal field and laboratory experimental  studie showing biological effects of noise on mechanistic pathways relating to risk factors for cardiovascular disease.

This experimental evidence, together with consistency with findings for road traffic noise, supports the likelihood that associations for aircraft noise with heart disease observed in epidemiological studies are causal. However, the exact magnitude of the exposure-response estimate for heart disease varies between studies and best estimates (obtained by combining results from good quality studies in a systematic review) are likely to change as further studies add to the evidence base.

There are important gaps in the evidence base for other outcomes. Perhaps surprisingly, few studies have been conducted in relation to impact of aircraft noise on mental health. There are also few studies relating to maternal health and birth outcomes including birth weight.

Generally, health studies to date have used Lden, Lday and Lnight metrics, most likely as these were available and had been extensively validated in annoyance studies. There is a need to examine other noise metrics that may be more relevant to health endpoints – some of the more recent studies are starting to include other metrics, including intermittency ratio,43 maximum noise level and to examine specific time periods,44 especially for night-time exposures. These new metrics should be additional, but not replace the standard equivalent metrics (LAeq, Lden) to allow for comparability of results, at least at present while the evidence base is being compiled.

The impact of aircraft noise on vascular and cardiac function in relation to noise event number: a randomized trial

Schmidt, Herzog, Schnorbus, Ostad, Lasetzki, Hahad, Schafers, Gori, Sørensen, Daiber, Munzel.

Cardiovascular Research 2020, doi:10.1093/cvr/cvaa204

(Schmidt 2020)

Aims: Night time aircraft noise exposure has been associated with increased risk of hypertension and myocardial infarction, mechanistically linked to sleep disturbance, stress, and endothelial dysfunction. It is unclear, whether the most widely used metric to determine noise exposure, equivalent continuous sound level (Leq), is an adequate indicator of the cardiovascular impact induced by different noise patterns.

Methods and results: In a randomized crossover study, we exposed 70 individuals with established cardiovascular disease or increased cardiovascular risk to two aircraft noise scenarios and one control scenario. Polygraphic recordings, echocardiography, and flow-mediated dilation (FMD) were determined for three study nights. The noise patterns consisted of 60 (Noise60) and 120 (Noise120) noise events, respectively, but with comparable Leq, corresponding to a mean value of 45 dB. Mean value of noise during control nights was 37 dB. During the control night, FMD was 10.02 3.75%, compared to 7.27 ± 3.21% for Noise60 nights and 7.21 ± 3.58% for Noise120 nights (P < 0.001). Sleep quality was impaired after noise exposure in both noise scenario nights (P < 0.001). Serial echocardiographic assessment demonstrated an increase in the E/E0 ratio, a measure of diastolic function, within the three exposure nights, with a ratio of 6.83 ± 2.26 for the control night, 7.21 ± 2.33 for Noise60 and 7.83 3.07 for Noise120 (P = 0.043).

Conclusions: Night time exposure to aircraft noise with similar Leq, but different number of noise events, results in a comparable worsening of vascular function. Adverse effects of nighttime aircraft noise exposure on cardiac function (diastolic dysfunction) seemed stronger the higher number of noise events.

The role of aircraft noise annoyance and noise sensitivity in the association between aircraft noise levels and hypertension risk: Results of a pooled analysis from seven European countries

Clemence Baudin, Marie Lefevre, Wolfgang Babisch, Ennio Cadum, Patricia

Champelovier, Konstantina Dimakopoulou, Danny Houthuijs, Jacques Lambert, Bernard Laumon, Goran Pershagen, Stephen Stansfeld, Venetia Velonaki, Anna Hansell, Anne-Sophie Evrard.

Environmental Research,

(Baudin 2020)


Introduction: Many studies, including the HYENA and the DEBATS studies, showed a significant association between aircraft noise exposure and the risk of hypertension.

Few studies have considered aircraft noise annoyanceand noise sensitivity as factors of interest, especially in relation to hypertension risk, or as mediating or modifying factors. The present study aims 1) to investigate the risk of hypertension in relation to aircraft noiseannoyance or noise sensitivity; and 2) to examine the role of modifier or mediator of these two factors in the association between aircraft noise levels and the risk of hypertension.

Methods: This study included 6,105 residents of ten European airports from the HYENA and DEBATS studies. Information on aircraft noise annoyance, noise sensitivity, and demographic, socioeconomic and lifestyle factors was collected during an interview performed at home. Participants were classified as hypertensive if they had either blood pressure levels above the WHO cut-off points or physician-diagnosed hypertension in conjunction with the use of antihypertensive medication. Outdoor aircraft noise exposure was estimated for each participant’s home address. Poisson regression models with adjustment for potential confounders were used. Interactions between noise exposure and country were tested to consider possible differences between countries.

Results: An increase in aircraft noise levels at night was weekly but significantly associated with an increased risk of hypertension (RR = 1.03, 95% CI 1.01–1.06 for a 10-dB(A) increase in Lnight). A significant association was found between aircraft noise annoyance and hypertension risk (RR = 1.06, 95%CI 1.00–1.13 for highly annoyed people compared to those who were not highly annoyed). The risk of hypertension was slightly higher for people highly sensitive to noise compared to people with low sensitivity in the UK (RR = 1.29, 95%CI 1.05-1.59) and in France (RR = 1.11, 95%CI 0.68-1.82), but not in the other countries. The association between aircraft noise levels and the risk of hypertension was higher among highly sensitive participants (RR = 1.00,

95%CI 0.96–1.04; RR = 1.03, 95%CI 0.90–1.11; RR = 1.12, 95%CI 1.01–1.24, with a 10-dB(A) increase in Lnight for low, medium,

Conclusion: This pooled analysis based on seven European countries was consistent with previous results suggesting that aircraft noise levels are associated, albeit weakly, with the risk of hypertension, and aircraft noise annoyance is associated with hypertension risk. They also suggest a possible modifying effect of aircraft noise annoyance in the relationship between aircraft noise exposure and the risk of hypertension. This is to our knowledge the first study to examine the role of noise sensitivity in the relationship between aircraft noise levels and hypertension risk, finding that this association was higher among highly sensitive participants. It is important that future studies of health effects related to noise exposure take noise annoyance and noise sensitivity into account, in particular by using appropriate statistical models related to mediation analysis and causal inference.

Saliva cortisol in relation to aircraft noise exposure: pooled-analysis results from seven European countries

Baudin, Lefèvre, Selander, Babisch, Cadum, Carlier, Champelovier, Dimakopoulou, Huithuijs, Lambert, Laumon, Pershagen, Theorell, Velonaki, Hansell, Evrard.

Environmental Health (2019) 18:102

(Baudin 2019b)


Background: Many studies have demonstrated adverse effects of exposure to aircraft noise on health. Possible biological pathways for these effects include hormonal disturbances. Few studies deal with aircraft noise effects on saliva cortisol in adults, and results are inconsistent.

Objective: We aimed to assess the effects of aircraft noise exposure on saliva cortisol levels and its variation in people living near airports.

Methods: This study focused on the 1300 residents included in the HYENA and DEBATS cross-sectional studies, with complete information on cortisol sampling. All the participants followed a similar procedure aiming to collect both a morning and an evening saliva cortisol samples. Socioeconomic and lifestyle information were obtained during a face-to-face interview. Outdoor aircraft noise exposure was estimated for each participant’s home address.

Associations between aircraft noise exposure and cortisol outcomes were investigated a priori for male and female separately, using linear regression models adjusted for relevant confounders. Different approaches were used to characterize cortisol levels, such as morning and evening cortisol concentrations and the absolute and relative variations between morning and evening levels.

Results: Statistically significant increases of evening cortisol levels were shown in women with a 10-dB(A) increase in aircraft noise exposure in terms of LAeq, 16h (exp(β) = 1.08; CI95% = 1.00–1.16), Lden (exp(β) = 1.09; CI95% = 1.01– 1.18), Lnight (exp(β) = 1.11; CI95% = 1.02–1.20). A statistically significant association was also found in women between a 10-dB(A) increase in terms of Lnight and the absolute variation per hour (exp(β) = 0.90; CI95% = 0.80–1.00). Statistically significant decreases in relative variation per hour were also evidenced in women, with stronger effects with the Lnight (exp(β) = 0.89; CI95% = 0.83–0.96) than with other noise indicators. The morning cortisol levels were unchanged whatever noise exposure indicator considered. There was no statistically significant association between aircraft noise exposure and cortisol outcomes in men.

Conclusions: The results of the present study show statistically significant associations between aircraft noise exposure and evening cortisol levels and related flattening in the (absolute and relative) variations per hour in women. Further biological research is needed to deepen knowledge of the pathway between noise exposure and disturbed hormonal regulation, and specially the difference in effects between genders.

Impacts on Physical Health

Effects of Aircraft Noise Exposure on Heart Rate during Sleep in the Population Living Near Airports

Nassur, Léger, Lefèvre, Elbaz, Mietlicki, Nguyen, Ribeiro, Sineau, Laumon, Evrard.

Int. J. Environ. Res. Public Health 2019, 16, 269; doi:10.3390/ijerph16020269

(Nassur 2019)


Background Noise in the vicinity of airports is a public health problem. Many laboratory studies have shown that heart rate is altered during sleep after exposure to road or railway noise. Fewer studies have looked at the effects of exposure to aircraft noise on heart rate during sleep in populations living near airports. Objective The aim of this study was to investigate the relationship between the sound pressure level (SPL) of aircraft noise and heart rate during sleep in populations living near airports in France. Methods In total, 92 people living near the Paris-Charles de Gaulle and ToulouseBlagnac airports participated in this study. Heart rate was recorded every 15 s during one night, using an Actiheart monitor, with simultaneous measurements of SPL of aircraft noise inside the participants’ bedrooms. Energy and event-related indicators were then estimated. Mixed linear regression models were applied, taking into account potential confounding factors, to investigate the relationship between energy indicators and heart rate during sleep measured every 15 s. Event-related analyses were also carried out in order to study the effects of an acoustic event associated with aircraft noise on heart rate during sleep. Results The more the SPL from all sources (LAeq,15s) and the SPL exceeded for 90% of the measurement period (LA90,15s) increased, the more heart rate also increased.

No significant associations were observed between the maximum 1-s equivalent SPL associated with aircraft overflight (LAmax,1s) and differences between the heart rate recorded during or 15 or 30 s after an aircraft noise event and that recorded before the event. On the other hand, a positive and significant association was found between LAmax,1s and the heart rate amplitude calculated during an aircraft noise event. Results were unchanged when analyses were limited to participants who had lived more than five years in their present dwelling. Conclusion Our study shows that exposure to the maximum SPL linked to aircraft overflight affect the heart rate during sleep of residents near airports. However, further studies on a larger number of participants over several nights are needed to confirm these results.

A Systematic Review of the Basis for WHOs New Recommendation for Limiting Aircraft Noise Annoyance

Truls Gjestland,

Int. J. Environ. Res. Public Health 2018, 15, 2717; doi:10.3390/ijerph15122717

(Gjestland 2018)


The new WHO Environmental Noise Guidelines for the European Region have recommendations for limiting noise exposure associated with adverse health effects. The limits are said to be based on a systematic review of existing evidence. This paper gives a systematic assessment of the presented evidence with respect to annoyance from aircraft noise. The new guidelines have been based on the results from a selection of existing aircraft noise studies. This paper demonstrates that a similar selection of other existing post-2000 studies will yield very different results. In addition, the validity of the presented evidence has been questioned as some of the referenced studies have not been conducted according to standardized methods, and the selection of respondents is not representative of the general airport population.

The Cost-Effectiveness of Lowering Permissible Noise Levels Around U.S. Airports

Jiao, Zafari, Will, Ruggeri, Li, Muennig

Int. J. Environ. Res. Public Health 2017, 14, 1497; doi:10.3390/ijerph14121497

(Jiao 2017)


Aircraft noise increases the risk of cardiovascular diseases and mental illness. The allowable limit for sound in the vicinity of an airport is 65 decibels (dB) averaged over a 24-hour ‘day and night’ period (DNL) in the United States. We evaluate the trade-off between the cost and the health benefits of changing the regulatory DNL level from 65 dB to 55 dB using a Markov model. The study used La Guardia Airport (LGA) as a case study. In compliance with 55 dB allowable limit of aircraft noise, sound insulation would be required for residential homes within the 55 dB to 65 dB DNL.A Markov model was built to assess the cost-effectiveness of installing sound insulation. One-way sensitivity analyses and Monte Carlo simulation were conducted to test uncertainty of the model.

The incremental cost-effectiveness ratio of installing sound insulation for residents exposed to airplane noise from LGA was $11,163/QALY gained (95% credible interval: cost-saving and life-saving to $93,054/QALY gained). Changing the regulatory standard for noise exposure around airports from 65 dB to 55 dB comes at a very good value.

Health Impairments, Annoyance and Learning Disorders Caused by Aircraft Noise – Synopsis of the State of Current Noise Research

Kaltenbach, Maschke, Heß, Niemann, Führ.

(Kaltenbach et al 2016)

International Journal of Environmental Protection Jan. 2016, Vol. 6 Iss. 1, PP. 15-46 Abstract

The article reviews the results of scientific research on aircraft noise induced health impairments, annoyance as well as learning disorders and summarizes consequences for legislative and political decisions.

The association of noise with an increased incidence of chronic arterial hypertension has been shown in large-scale epidemiological studies. Identified risks are up to 20% per 10 dB increase in day-evening-night level (above 50 dB(A)) and for nightly noise exposure within a range of 19-34% per10 dB (above 30-35dB(A)). Identified risks regarding the use of antihypertensive drugs are partly higher. Also an increase in strokes is documented in recent epidemiological studies and understood as a consequence of hypertension. The same applies in the case of heart failure. Likewise an increase in myocardial infarctions has been confirmed in the recent studies with large populations included.

Moreover, the annoyance due to aircraft noise has been significantly underestimated in the last 15 years. Compared to the EU-position paper of 2002 the sound level at a given extent of annoyance (25% HA) is at least 10 dB(A) lower. Impairments of cognitive performance in children attending schools exposed to high aircraft noise have been demonstrated in national and international studies up to the year 2014. As consequence of the present knowledge in noise effect research legal and political decisions must form the base to reduce aircraft noise exposure during the 24h-day to Lden = 50 and during the night to Ln = 45 dB(A).

Myocardial Infarction Risk Due to Aircraft, Road, and Rail Traffic Noise – Results of a Case–Control Study Based on Secondary Data

Seidler, Wagner, Schubert, Dröge, Jön Pons-Kühnemann, Swart, Zeeb, Hegewal.

Dtsch Arztebl Int 2016; 113: 407–14.  DOI: 10.3238/arztebl.2016.0407

(Seidler 2016)

Background: Traffic noise can induce stress reactions that have effects on the cardiovascular system. The exposure–risk relationship between aircraft, road, and rail traffic noise and myocardial infarction is currently unknown.

Method: 19 632 patients from the Rhine-Main region of Germany who were diagnosed with myocardial infarction in the years 2006–2010 were compared with 834 734 control subjects. The assignment of persons to groups was per¬formed on the basis of billing and prescription data from three statutory health insurance carriers. The exposure of all insurees to aircraft, road, and rail traffic noise in 2005 was determined from their residence addresses. As estimators of risk, odds ratios (OR) were calculated by logistic regression analysis, with adjustment for age, sex, regional social status variables, and individual social status (if available). The evaluation was performed on the basis of the continuous 24-hour noise level and the categorized noise level (in 5 decibel classes).

Results: The linear model revealed a statistically significant risk increase due to road noise (2.8% per 10 dB rise, 95% confidence interval [1.2; 4.5]) and railroad noise (2.3% per 10 dB rise [0.5; 4.2]), but not airplane noise. Airplane noise levels of 60 dB and above were associated with a higher risk of myocardial infarction (OR 1.42 [0.62; 3.25]). This higher risk is statistically significant if the analysis is restricted to patients who had died of myocardial infarction by 2014/2015 (OR 2.70 [1.08; 6.74]. In this subgroup, the risk estimators for all three types of traffic noise were of comparable magnitude (3.2% to 3.9% per 10 dB rise in noise level).

Conclusion: In this study, a substantial proportion of the population was ex¬posed to traffic noise levels that were associated with an albeit small increase in the risk of myocardial infarction. These findings underscore the importance of effective traffic noise prevention.

Cardiovascular effects of environmental noise exposure

Munzel, Gori, Babisch, Basner.

European Heart Journal (2014) 35, 829–836 doi:10.1093/eurheartj/ehu030

(Munzel 2014)

The role of noise as an environmental pollutant and its impact on health are being increasingly recognized. Beyond its effects on the auditory system, noise causes annoyance and disturbs sleep, and it impairs cognitive performance. Furthermore, evidence from epidemiologic studies demonstrates that environmental noise is associated with an increased incidence of arterial hypertension, myocardial infarction, and stroke. Both observational and experimental studies indicate that in particular night-time noise can cause disruptions of sleep structure, vegetative arousals (e.g. increases of blood pressure and heart rate) and increases in stress hormone levels and oxidative stress, which in turn may result in endothelial dysfunction and arterial hypertension. This review focuses on the cardiovascular consequences of environmental noise exposure and stresses the importance of noise mitigation strategies for public health.

Conclusions. Taken together, the present review provides evidence that noise not only causes annoyance, sleep disturbance, or reductions in quality of life, but also contributes to a higher prevalence of the most important cardiovascular risk factor arterial hypertension and the incidence of Cardiovascular effects of environmental noise exposure cardiovascular diseases. The evidence supporting such contention is based on an established rationale supported by experimental laboratory and observational field studies, and a number of epidemiological studies. Meta-analyses have been carried out to derive exposure–response relationships that can be used for quantitative health impact assessments. Noise-induced sleep disturbance constitutes an important mechanism on the pathway from chronic noise exposure to the development of adverse health effects. The results call for more initiatives aimed at reducing environmental noise exposure levels to promote cardiovascular and public health.

Recent studies indicate that people’s attitude and awareness in particular towards aircraft noise has changed over the years. Noise mitigation policies have to consider the medical implications of environmental noise exposure. Noise mitigation strategies to improve public health include noise reduction at the source, active noise control (e.g.

noise optimized take-off and approach procedures), optimized traffic operations (including traffic curfews), better infrastructural planning, better sound insulation in situations where other options are not feasible, and adequate limit values.

Exposure to aircraft and road traffic noise and associations with heart disease and stroke in six European countries: a cross-sectional study

Floud, Marta Blangiardo, Clark,  de Hoogh, Babisch, Houthuijs, Swart, Pershagen, Klea Katsouyanni, Velonakis, Vigna-Taglianti, Cadum, Hansell

Environmental Health 2013, 12:89

(Floud 2013)


Background: Although a number of studies have found an association between aircraft noise and hypertension, there is a lack of evidence on associations with other cardiovascular disease. For road traffic noise, more studies are available but the extent of possible confounding by air pollution has not been established.

Methods: This study used data from the Hypertension and Environmental Noise near Airports (HYENA) study.

Cross-sectional associations between self-reported ‘heart disease and stroke’ and aircraft noise and road traffic noise were examined using data collected between 2004 and 2006 on 4712 participants (276 cases), who lived near airports in six European countries (UK, Germany, Netherlands, Sweden, Greece, Italy). Data were available to assess potential confounding by NO2 air pollution in a subsample of three countries (UK, Netherlands, Sweden).

Results: An association between night-time average aircraft noise and ‘heart disease and stroke’ was found after adjustment for socio-demographic confounders for participants who had lived in the same place for ≥ 20 years (odds ratio (OR): 1.25 (95% confidence interval (CI) 1.03, 1.51) per 10 dB (A)); this association was robust to adjustment for exposure to air pollution in the subsample. 24 hour average road traffic noise exposure was associated with ‘heart disease and stroke’ (OR: 1.19 (95% CI 1.00, 1.41), but adjustment for air pollution in the subsample suggested this may have been due to confounding by air pollution. Statistical assessment (correlations and variance inflation factor) suggested only modest collinearity between noise and NO2 exposures.

Conclusions: Exposure to aircraft noise over many years may increase risks of heart disease and stroke, although more studies are needed to establish how much the risks associated with road traffic noise may be explained by air pollution.

Aircraft noise and cardiovascular disease near Heathrow airport in London: small area study

Hansell, Blangiardo, Fortunato, Floud, de Hoogh, Fecht, Ghosh, Laszlo, Pearson, Beale, Gulliver, Best, Richardson, Elliott.

BMJ 2013;347:f5432 doi: 10.1136/bmj.f5432 (Published 8 October 2013)

(Hansell 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 2,378 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.

Airport noise and cardiovascular disease The link seems real: planners take note

Stephen Stansfeld, BMJ 2013;347:f5752 doi: 10.1136/bmj.f5752

(Stansfeld 2013)


These new studies add to the research evidence linking noise exposure and cardiovascular disease. The largest comparable recent study was a follow-up of the Swiss national cohort in which aircraft noise was associated with mortality from myocardial infarction, in a dose-response manner according to the level and duration of exposure.6 Exposure to aircraft noise was linked to cardiovascular risk factors, such as hypertension, in an dose-response manner in the HYENA (Hypertension and Exposure to Noise near Airports) study. This is the largest study of aircraft noise and hypertension to date, involving 4861 participants living around seven European airports. A linked substudy on acute noise found an increase in participants’ blood pressure when they were sleeping regardless of the source of the noise (road traffic noise, aircraft noise, or noise from inside the home).

Increased rates of prescription for cardiovascular drugs and antihypertensive drugs have also been related to exposure to aircraft noise, although the results for antihypertensive drugs were inconsistent.8 9 A meta-analysis of five studies of hypertension and exposure to aircraft noise reported a pooled estimate odds ratio of 1.13 for an increase of 10 dB (95% confidence interval 1.00 to 1.28; range 45-70 dB).10 However, only one aircraft noise study has shown an increased incidence of hypertension.11

These studies provide preliminary evidence that aircraft noise exposure is not just a

cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.

The cost of hypertension-related ill health attributable to environmental noise

Noise and Health, November 2013 DOI: 10.4103/1463-1741.121253

(Harding 2013)


Context: Hypertension is associated with environmental noise exposure, and is a risk factor for a range of health outcomes.

Aims: The study aims were to identify key hypertension related health outcomes and to quantify and monetise the impact on health outcomes attributable to environmental noise-related hypertension.

Methods: A reiterative literature review identified key hypertension related health outcomes, and their quantitative links with hypertension. The health impact of increases in environmental noise above recommended daytime noise levels (55 dB(A)) were quantified in terms of Quality Adjusted Life Years, and then monetised. A case study evaluated the cost of environmental noise, using published data on health risks and the number of people exposed to various bands of environmental noise levels in the United Kingdom.

Results: Three health outcomes were selected based on the strength of evidence linking them with hypertension and their current impact on society: acute myocardial infarction (AMI), stroke and dementia. In the United Kingdom population, an additional 1257 cases of hypertension-related AMI, 1818 cases of stroke, and 2707 cases of dementia were expected per year due to day-evening-night noise levels ≥ 55 dB(A). The cost of these additional cases was valued at around £2.5 billion, with dementia accounting for 44%.

Conclusions: The methodology is dependent on the availability and quality of published data, and the resulting valuations reflect these limitations. The estimated intangible cost provides an insight into the scale of the health impacts and conversely the benefits that the implementation of policies to manage environmental noise may confer.

Medication use in relation to noise from aircraft and road traffic in six European countries: results of the HYENA study

Floud, Vigna-Taglianti, Hansell, Blangiardo, Houthuijs, Breugelmans, Cadum, Babisch,

Selander, Pershagen, Antoniotti, Pisani, Dimakopoulou, Haralabidis, Velonakis, Jaru

Occup Environ Med 2011;68:518e524. doi:10.1136/oem.2010.058586

(Floud 2010)


Objectives Studies on the health effects of aircraft and road traffic noise exposure suggest excess risks of hypertension, cardiovascular disease and the use of sedatives and hypnotics. Our aim was to assess the use of medication in relation to noise from aircraft and road traffic.

Methods This cross-sectional study measured the use of prescribed antihypertensives, antacids, anxiolytics, hypnotics, antidepressants and antasthmatics in 4,861 persons living near seven airports in six European countries (UK, Germany, the Netherlands, Sweden, Italy, and Greece). Exposure was assessed using models with 1dB resolution

(5dB for UK road traffic noise) and spatial resolution of 2,503,250m for aircraft and 10,310m for road traffic noise. Data were analysed using multilevel logistic regression, adjusting for potential confounders.

Results We found marked differences between countries in the effect of aircraft noise on antihypertensive use; for night-time aircraft noise, a 10dB increase in exposure was associated with ORs of 1.34 (95% CI 1.14 to1.57) for the UK and 1.19 (1.02 to 1.38) for the Netherlands but no significant associations were found for other countries. For daytime aircraft noise, excess risks were found for the UK (OR 1.35; CI: 1.13 to 1.60) but a risk deficit for Italy (OR 0.82; CI: 0.71 to 0.96). There was an excess risk of taking anxiolytic medication in relation to aircraft noise (OR 1.28; CI: 1.04 to 1.57 for daytime and OR 1.27; CI: 1.01 to 1.59 for night-time) which held across countries. We also found an association between exposure to 24hr road traffic noise and the use of antacids by men (OR 1.39; CI 1.11 to 1.74).

Conclusion Our results suggest an effect of aircraft noise on the use of antihypertensive medication, but this effect did not hold for all countries. Results were more consistent across countries for the increased use of anxiolytics in relation to aircraft noise. ———

A Review of the Literature Related to Potential Health Effects of Aircraft Noise

PARTNER Project 19 Final Report prepared by Hales Swift July 2010

(Swift 2010)

Previous reports have dealt with the “health effects of noise” in some capacity. Many of these have considered various quality of life factors as the primary health effects. This is in line with the World Health Organization (WHO, 1946) definition of health, which reads, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Noise was seen as detracting primarily from mental well being (annoyance for instance) or social well being (speech interference).

However, recent studies have demonstrated a possible relationship between noise exposure, such as that caused by aircraft, and the more physiological side of the WHO definition: disease or infirmity. Led in part by industrial and laboratory studies showing acute effects such as transient blood pressure increases, a number of other recent studies have been conducted showing a mixture of possible short and long-term cardiovascular effects of noise. While not all studies have resulted in significant findings, a pattern of increased incidence of cardiovascular effects, hypertension and ischemic heart disease in particular, seems to have emerged. These purpoted effects are only recently documented and thus models accounting for their hypothesized societal costs are still in early stages.

A feature of this literature survey is its emphasis on cardiovascular outcomes and an evaluation of the potential pathways from aircraft noise to health outcomes for possible cardiovascular endpoints. This is in contrast to most previous reports on this subject, which were not focused as much on potential mechanisms for the proposed or observed effects. Two potential pathways are discussed: sleep disruption and noise induced stress; because both have been related to possible cardiovascular outcomes. The relationship between aircraft noise and annoyance, disturbance of communication, and disruption of learning leading to delays in reading proficiency or difficulties in remembering material, have been reviewed elsewhere and readers are referred to that literature. However, a brief review of these topics is given in this report. The focus on the two pathways primarily covered in this report is because of the results of recent studies in Europe focused on the health impacts of transportation noise. Through these studies researchers have shown nighttime aircraft noise to be more highly correlated to health impacts than twenty-four hour or daytime noise, and have found that observed effects in road noise studies have become stronger when house orientation and window opening habits at night have been taken into account. Research into health effects of industrial noise exposure as well as health effects associated with annoyance from community noise suggests that stress reactions, such as arousal of the cardiovascular system in response to a loud noise, may lead to negative cardiovascular outcomes as well. It has been proposed that repeated short-term increases of blood pressure and heart rate associated with these reactions may lead to changes in the functioning of the cardiovascular system and eventual hypertension. Thus, both sleep and stress, because they have been proposed as pathways leading from noise exposure to eventual cardiovascular outcomes, are of interest and have been focused on in this report.

There are several potential problems that arise in health studies, e.g., unaccounted for confounding factors; removal of the impacts of certain factors which are known to be risk factors for cardiovascular disease but might also be outcomes of the noise exposure; inaccurate prediction of exposure to noise sources of interest; difficulties disambiguating impacts of total noise exposure versus exposure to a particular noise source of interest. In addition, adequate control of other factors like air quality, which may also be influenced by noise producing infrastructure, may pose challenges and increase the diversity of expertise needed for an effective study. As an example of the potential difficulties of confounding, shortening, fragmenting, or changing the stage structure of sleep may lead to increases in the prevalence of obesity, diabetes, hypertension and heart disease — noted components of the metabolic syndrome.

However, obesity and diabetes (also potentially outcomes of sleep problems) seem to have been examined primarily as confounders in these noise and health studies. In assessing relevant exposures, it is rare that an observed effect is clearly and solely attributable to the noise source of interest, as total noise exposure (in work, while commuting, at home or elsewhere in the community) is rarely assessed. Further, the actual exposure inside the home may deviate considerably from the outdoor level and predictions even of outdoor exposure may not be accurate, although the accuracy is steadily improving with increased computational capability. In future studies, it will be important to be able to address all of these issues so that a more accurate assessment of aircraft noise impacts can be made.

Potential cardiovascular health effects of exposure to aircraft noise need to be quantified so that the economic and ease-of-travel benefits of airports can be weighed against potential health effects of noise and other pollutants. Currently, hedonic measures are used to assess the negative impacts of noise around airports, yet it does not seem likely that they would reflect the impacts of cardiovascular effects of noise, which are largely unknown in the general population. Some would argue that hedonic measures do not even reflect non health-related quality of life effects, because people need to experience noise exposure before they truly understand its impacts, and the ability to move is limited once a house has been purchased.

Others make strong arguments in favor of hedonic measures. With regards to cardiovascular health effects, it may be possible to extend the usefulness of hedonic measures through education of the public concerning potential risks, enabling them to make more informed choices when purchasing their homes. Other possibilities include the use of the system of Disability Adjusted Life Years (DALY’s), which has been recommended as an effective decision making tool where both quality of life and disease issues were being considered in balance alongside potential economic benefits. This system is also used for other disease related and quality-of-life outcomes resulting from air quality and climate change. Thus, using such a system it might be possible to better understand the relative contributions of each of these three undesirable outcomes of aircraft operations.

Saliva Cortisol and Exposure to Aircraft Noise in Six European Countries

Selander, Bluhm, Theorell, Pershagen, Babisch, Seiffert, Houthuijs, Breugelmans, Vigna-Taglianti, Antoniotti, Velonakis, Davou, Dudley, Järup

Environ Health Perspect 117:1713–1717 (2009). doi:10.1289/ehp.0900933 available via

(Selandedr 2009)

Objective: Our objective was to assess saliva cortisol concentration in relation to exposure to aircraft noise.

Method: A multicenter cross-sectional study, HYENA (Hypertension and Exposure to Noise near Airports), comprising 4,861 persons was carried out in six European countries. In a subgroup of 439 study participants, selected to enhance the contrast in exposure to aircraft noise, saliva cortisol was assessed three times (morning, lunch, and evening) during 1 day.

Results: We observed an elevation of 6.07 nmol/L [95% confidence interval (CI), 2.32– 9.81 nmol/L] in morning saliva cortisol level in women exposed to aircraft noise at an average 24-hr sound level (LAeq,24h) > 60 dB, compared with women exposed to LAeq,24h ≤ 50 dB, corresponding to an increase of 34%. Employment status appeared to modify the response. We found no associa¬tion between noise exposure and saliva cortisol levels in men.

Conclusions: Our results suggest that exposure to aircraft noise increases morning saliva cortisol levels in women, which could be of relevance for noise-related cardiovascular effects.

Hypertension and Exposure to Noise Near Airports: the HYENA Study

Jarup, Babisch, Houthuijs, Pershagen, Katsouyanni, Cadum, Dudley, Savigny, Seiffert,

Swart, Breugelmans, Bluhm, Selander, Haralabidis, Dimakopoulou, Sourtzi, Velonakis, Vigna-Taglianti

Environ Health Perspect, 116:329–333 (2008). doi:10.1289/ehp.10775,

(Jarup 2008)

BACKGROUND: An increasing number of people are exposed to aircraft and road traffic noise. Hypertension is an important risk factor for cardiovascular disease, and even a small contribution in risk from environmental factors may have a major impact on public health.

OBJECTIVES: The HYENA (Hypertension and Exposure to Noise near Airports) study aimed to assess the relations between noise from aircraft or road traffic near airports and the risk of hypertension.

METHODS: We measured blood pressure and collected data on health, socioeconomic, and lifestyle factors, including diet and physical activity, via questionnaire at home visits for 4,861 persons 45–70 years of age, who had lived at least 5 years near any of six major European airports. We assessed noise exposure using detailed models with a resolution of 1 dB (5 dB for United Kingdom road traffic noise), and a spatial resolution of 250 × 250 m for aircraft and 10 × 10 m for road traffic noise.

RESULTS: We found significant exposure–response relationships between night-time aircraft as well as average daily road traffic noise exposure and risk of hypertension after adjustment for major confounders. For night-time aircraft noise, a 10-dB increase in exposure was associated with an odds ratio (OR) of 1.14 [95% confidence interval (CI), 1.01–1.29]. The exposure–response relationships were similar for road traffic noise and stronger for men with an OR of 1.54 (95% CI, 0.99–2.40) in the highest exposure category (> 65 dB; ptrend = 0.008).

CONCLUSIONS: Our results indicate excess risks of hypertension related to long-term noise exposure, primarily for night-time aircraft noise and daily average road traffic noise.

Health Consequences of Aircraft Noise

Martin Kaltenbach, Christian Maschke, and Rainer Klinke

Dtsch Arztebl Int. 2008 Aug; 105(31-32): 548–556. Published online 2008 Aug 4. doi:

10.3238/arztebl.2008.0548. PMCID: PMC2696954, PMID: 19593397

(Kaltenbach 2008)


The ever-increasing level of air traffic means that any medical evaluation of its effects must be based on recent data.


Selective literature review of epidemiological studies from 2000 to 2007 regarding the illnesses, annoyance, and learning disorders resulting from aircraft noise.


In residential areas, outdoor aircraft noise-induced equivalent noise levels of 60 dB(A) in the daytime and 45 dB(A) at night are associated with an increased incidence of hypertension. There is a dose-response relationship between aircraft noise and the occurrence of arterial hypertension. The prescription frequency of blood pressurelowering medications is associated dose-dependently with aircraft noise from a level of about 45 dB(A). Around 25% of the population are greatly annoyed by exposure to noise of 55 dB(A) during the daytime. Exposure to 50 dB(A) in the daytime (outside) is associated with relevant learning difficulties in schoolchildren.


Based on recent epidemiological studies, outdoor noise limits of 60 dB(A) in the daytime and 50 dB(A) at night can be recommended on grounds of health protection. Hence, maximum values of 55 dB(A) for the day and 45 dB(A) for the night should be aimed for in order to protect the more sensitive segments of the population such as children, the elderly, and the chronically ill. These values are 5 to10 dB(A) lower than those specified by the German federal law on aircraft noise and in the report “synopsis” commissioned by the company that runs Frankfurt airport (Fraport).

The most informative new studies relate to hypertension, annoyance, and learning difficulties. As far as may be deduced from the findings, absolute changes in risk were reported. A study of road traffic noise annoyance and a meta-analysis showed a significant noise-related increase in myocardial infarctions from continuous daytime noise levels of 60 dB(A) upwards. No studies exploring a relationship with aircraft noise are available. This association is therefore not examined more closely. There is no doubt, however, that every increase in arterial hypertension can lead to more infarctions and strokes.

Learning difficulties

Noise can impair human mental performance without detectable organic damage. Stansfeld et al. studied 2844 children aged 9 to 10 years in 89 schools. These children showed a significant relationship between the deterioration in silent reading comprehension and certain memory performances and increasing aircraft noise exposure at schools . Reading comprehension showed a linear decrease with increasing noise, while the subjective annoyance showed a logarithmic increase.

Acute effects of night-time noise exposure on blood pressure in populations living near airports

Haralabidis, Dimakopoulou, Vigna-Taglianti, Giampaolo, Borgini, Dudley,  Pershagen, Bluhm, Houthuijs, Babisch, Velonakis, Katsouyanni and Jarup.

2008, European Heart Journal doi:10.1093/eurheartj/ehn013

(Haralabidis 2008)

In the present study the effect of environmental noise on BP and HR during night-time sleep of persons living in the vicinity of four major European airports was investigated within the wider framework of the HYENA (hypertension and exposure to noise near airports) project.

Non-invasive ambulatory BP measurements at 15 min intervals were performed. Noise was measured during the night sleeping period and recorded digitally for the identification of the source of a noise event. Exposure variables included equivalent noise level over 1 and 15 min and presence/absence of event (with LAmax 35 dB) before each BP measurement. Random effects models for repeated measurements were applied. An increase in BP (6.2 mmHg (0.63–12) for systolic and 7.4 mmHg (3.1, 12) for diastolic) was observed over 15 min intervals in which an aircraft event occurred. A non-significant increase in HR was also observed (by 5.4 b.p.m.). Less consistent effects were observed on HR. When the actual maximum noise level of an event was assessed there were no systematic differences in the effects according to the noise source.

Conclusion: Effects of noise exposure on elevated subsequent BP measurements were clearly shown. The effect size of the noise level appears to be independent of the noise source.

Aircraft noise around a large international airport and its impact on general health and medication use

Franssen, van Wiechen, Nagelkerke, Lebret

Occup Environ Med 2004;61:405–413. doi: 10.1136/oem.2002.005488

(Franssen 2004)

Aims: To assess the prevalence of general health status, use of sleep medication, and use of medication for cardiovascular diseases, and to study their relation to aircraft noise exposure.

Methods: These health indicators were measured by a cross-sectional survey among 11 812 respondents living within a radius of 25 km around Schiphol airport (Amsterdam).

Results: Adjusted odds ratios ranged from 1.02 to 2.34 per 10 dB(A) increase in Lden. The associations were statistically significant for all indicators, except for use of prescribed sleep medication or sedatives and frequent use of this medication. None of the health indicators were associated with aircraft noise exposure during the night, but use of non-prescribed sleep medication or sedatives was associated with aircraft noise exposure during the late evening (OR = 1.72). Vitality related health complaints such as tiredness and headache were associated with aircraft noise, whereas most other physical complaints were not. Odds ratios for the vitality related complaints ranged from 1.16 to 1.47 per 10 dB(A) increase in Lden.

A small fraction of the prevalence of poor self rated health (0.13), medication for cardiovascular diseases or increased blood pressure (0.08), and sleep medication or sedatives (0.22) could be attributed to aircraft noise. Although the attributable fraction was highest in the governmentally noise regulated area, aircraft noise had more impact in the non-regulated area, due to the larger population.

Conclusions: Results suggest associations between community exposure to aircraft noise and the health indicators poor general health status, use of sleep medication, and use of medication for cardiovascular diseases.

Impacts on Mental Health

Transportation noise exposure and anxiety: a systematic review and metaanalysis

Lan, Y., Roberts, H., Kwan, M.-P., Helbich, M.,

Environmental Research,

(Lan 2020)


Background: Exposure to transportation noise is hypothesized to contribute to anxiety, but consistent associations have not been established.

Objective: To provide a comprehensive synthesis of the literature by examining associations between traffic-related noise (i.e., road traffic noise, railway noise, aircraft noise and mixed traffic noise) and anxiety.

Methods: We systematically searched Web of Science, Scopus, Embase, PubMed, and PsycINFO for English-language observational studies published up to February 2020 reporting on the traffic noise-anxiety association. We appraised the risk of bias using an assessment tool and the quality of evidence following established guidelines. A random effects meta-analysis was performed for pooled and separated traffic-related noise sources.

Results: Of the 3,575 studies identified, 11 fulfilled the inclusion criteria and 9 studies were appropriate for meta-analysis. For the pooled overall effect size between transport noise and anxiety, we found 9% higher odds of anxiety associated with a 10 dB(A) increase in day-evening-night noise level (Lden), with moderate heterogeneity (OR=1.09, 95% CI: 0.97-1.23, I2=70%). The association was more likely to be significant with more severe anxiety. Subgroup analysis revealed that the effects of different noise sources on anxiety were inconsistent and insignificant. The quality of evidence was rated as very low to low.

Conclusions: Our findings support the hypothesis of an association between traffic noise and more severe anxiety. More high-quality studies are needed to confirm associations between different noise types and anxiety, as well as to better understand underlying mechanisms.

Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis

Schubert, Hegewald, Freiberg, Starke, Augustin, Riedel-Heller, Zeeb,

Int. J. Environ. Res. Public Health 2019, 16, 3336; doi:10.3390/ijerph16183336

(Schubert 2019)

Abstract: Children and adolescents may be particularly vulnerable to environmental influences such as noise which can aect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Diffculties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9–10 years and 15–17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total diffculties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04–1.19), respectively 9% (95% CI 1.02–1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total diffculties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.

Aircraft Noise and Psychological Ill-Health: The Results of a Cross-Sectional Study in France

Baudin, Lefèvre, Champelovier, Lambert, Laumon, Evrard 1.

Int. J. Environ. Res. Public Health 2018, 15, 1642; doi:10.3390/ijerph15081642

(Baudin 2018)


Background: The effects of aircraft noise on psychological ill-health have not been largely investigated and remain to be discussed. No study has been performed in France on the health effects of aircraft noise. Objectives: The present study aimed to investigate the relationship between aircraft noise in dB and in terms of annoyance and psychological ill-health in populations living near airports in France. Methods: A total of 1244 individuals older than 18 and living near three French airports (Paris–Charles de Gaulle, Lyon–Saint-Exupéry and Toulouse–Blagnac) were randomly selected to participate in the study. Information about their personal medical history and socioeconomic and lifestyle factors was collected by means of a face-to-face questionnaire performed at their place of residence by an interviewer. Psychological illhealth was evaluated with the 12-item version of the General Heath Questionnaire (GHQ-12). For each participant, outdoor aircraft noise exposure in dBwas estimated by linking their home address to noise maps. Objective noise exposure in dB was considered to be the primary exposure of interest. Four noise indicators referring to three different periods of the day were derived and used for the statistical analyses: Lden, LAeq,24hr, LAeq,6hr–22hr, and Lnight.

Noise annoyance and noise sensitivity were the secondary risk factors of interest. Logistic regression models were used with adjustment for potential confounders. Results: The participation rate in the study was 30%. Approximately 22% of the participants were considered to have psychological ill-health according to the GHQ12. No direct association was found between exposure to aircraft noise in dB and psychological ill-health. However, annoyance due to aircraft noise and noise sensitivity were both significantly associated with psychological ill-health. Moreover, a gradient was evidenced between annoyance and psychological ill-health, with increasing ORs from 1.79 (95% CI 1.06–3.03) for people who were not all annoyed to 4.00 (95% CI 1.67–9.55) for extremely annoyed people.

Conclusions: These findings confirm the results of previous studies, suggesting there is no direct association between aircraft noise exposure in dB and psychological illhealth, but there is a significant relationship between noise sensitivity or annoyance due to aircraft noise and psychological ill-health. This supports the hypothesis that psychological aspects, such as noise annoyance and noise sensitivity, play important roles in the association between environmental noise and adverse effects on health. However, further studies are necessary in order to better understand the links between these variables.

Effects of aircraft noise on annoyance, sleep disorders, and blood pressure among adult residents near the Orio al Serio International Airport (BGY), Italy

Carugno, Imbrogno, Zucchi, Ciampichini, Tereanu, Sampietro, Barbaglio, Pesenti, Barretta, Bertazzi, Pesatori, Consonni.

Med Lav 2018; 109, 4: 253-263 DOI: 10.23749/mdl.v109i4.7271

(Carugno 2018)


Background: Aircraft noise may cause several non-auditory health effects, including annoyance, sleep disorders,hypertension, cardiovascular diseases, and impaired cognitive skills in children.

Objectives: To perform a cross-sectional study among adult residents near the Orio al Serio International Airport (BGY), Italy to investigate the association between aircraft noise, annoyance, sleep disorders, blood pressure levels, and prevalence of hypertension.

Methods: Residential addresses of subjects aged 45-70 years were geocoded and classified in three groups according to noise levels: <60 (Reference), 60-65 (Zone A), and 65-75 dBA (Zone B). A sample of subjects was invited to undergo a personal interview and blood pressure measurements. Multiple linear and robust Poisson regression models were used to analyze quantitative and categorical variables, respectively.

Results: Between June and September 2013,we enrolled 400 subjects (166 in the Reference Zone, 164 in Zone A, and 70 in Zone B). Compared to the Reference Zone, we found elevated adjusted annoyance scores (day and night) in Zone A (+2.7) and Zone B (+4.0) (p<0.001) and about doubled proportions of severely annoyed subjects

(p<0.001). Reported sleep disorders in the previous month were also more frequent in Zones A and B. Sleep disorders in general were 19.9% in the Reference Zone, 29.9% in Zone A, and 35.7% in Zone B (p<0.001).

Conclusions: We found a strong association between aircraft noise levels, annoyance, and sleep disorders among adult residents near the Orio al Serio International Airport. We found no relationship with blood pressure levels and prevalence of hypertension.

WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Cognition

Charlotte Clark, and Katarina Paunovic,

Int. J. Environ. Res. Public Health 2018, 15, 285; doi:10.3390/ijerph15020285

(Clark 2018)


This systematic review assesses the quality of the evidence across individual studies on the effect of environmental noise (road traffic, aircraft, and train and railway noise) on cognition. Quantitative non-experimental studies of the association between environmental noise exposure on child and adult cognitive performance published up to June 2015 were reviewed: no limit was placed on the start date for the search. A total of 34 papers were identified, all of which were of child populations. 82% of the papers were of cross-sectional design, with fewer studies of longitudinal or intervention design. A range of cognitive outcomes were examined. The quality of the evidence across the studies for each individual noise source and cognitive outcome was assessed using an adaptation of GRADE methodology. This review found, given the predominance of cross-sectional studies, that the quality of the evidence across studies ranged from being of moderate quality for an effect for some outcomes, e.g., aircraft noise effects on reading comprehension and on long-term memory, to no effect for other outcomes such as attention and executive function and for some noise sources such as road traffic noise and railway noise. The GRADE evaluation of low quality evidence across studies for some cognitive domains and for some noise sources does not necessarily mean that there are no effects: rather, that more robust and a greater number of studies are required.

Association between aircraft, road and railway traffic noise and depression in a large case-control study based on secondary data

Seidlera, Hegewalda, Seidlera, Schuberta, Wagnera, Drögea, Haufea, Schmitta, Swartc, Zeebd.

(Seidlera 2017)

Background: Few studies have examined the relationship between traffic noise and depression providing inconclusive results. This large case-control study is the first to assess and directly compare depression risks by aircraft, road traffic and railway noise.

Methods: The study population included individuals aged ≥40 years that were insured by three large statutory health insurance funds and were living in the region of Frankfurt international airport. Address-specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Based on insurance claims and prescription data, 77,295 cases with a new clinical depression diagnosis between 2006 and 2010 were compared with 578,246 control subjects.

Results: For road traffic noise, a linear exposure-risk relationship was found with an odds ratio (OR) of 1.17 (95% CI=1.10–1.25) for 24-h continuous sound levels ≥70 dB. For aircraft noise, the risk estimates reached a maximum OR of 1.23 (95% CI=1.19– 1.28) at 50–55 dB and decreased at higher exposure categories. For railway noise, risk estimates peaked at 60–65 dB (OR=1.15, 95% CI=1.08–1.22). The highest OR of 1.42 (95% CI=1.33–1.52) was found for a combined exposure to noise above 50 dB from all three sources.

Conclusions: This study indicates that traffic noise exposure might lead to depression. As a potential explanation for the decreasing risks at high traffic noise levels, vulnerable people might actively cope with noise (e.g. insulate or move away).

The relationship between aircraft sound levels, noise annoyance and mental well-being: An analysis of moderated mediation

Dirk Schreckenberg, Sarah Benz, Christin Belke, Ulrich Möhler, Rainer Guski

2017 12th ICBEN Congress on Noise as a Public Health Problem

(Schreckenberg 2017)


The evidence of a relationship between environmental noise exposure and mental health-related quality of life (HQoL) is inconsistent. Several studies have shown an association betweennoise annoyance and mental HQoL. This has been interpreted in terms of a mediation effect of annoyance on mental health. The reversed hypothesis that individuals with poor mental health have low resources to cope with noise and thus are more annoyed is also discussed.

For aircraft noise at Frankfurt Airport, both hypotheses that annoyance mediates the impact of noise exposure on mental HQoL and that mental HQoL contributes to the prediction of annoyance were analysed using longitudinal data of the NORAH study (Noise-related annoyance, cognition, and health). Results of SEM and OLS regressions indicate that annoyance mediates the effect of aircraft sound exposure on mental HQoL. During two years of measurement after the opening of a new runway this mediation effect is stronger for higher aircraft sound levels. The analyses also revealed a reciprocal association between noise annoyance and mental HQoL. In addition to annoyance, the change in noise exposure since 2011 affects mental HQoL.

Noise Annoyance Is Associated with Depression and Anxiety in the General Population – The Contribution of Aircraft Noise

Beutel, Jünge, Klein, Wild3, Lackner, Blettner, Binder, Michal, Wiltink, Brähler, Münzel

PLOS ONE | DOI:10.1371/journal.pone.0155357 May 19, 2016

(Beutel 2016)

Background: While noise annoyance has become recognized as an important environmental stressor, its association to mental health has hardly been studied. We therefore determined the association of noise annoyance to anxiety and depression and explored the contribution of diverse environmental sources to overall noise annoyance.

Patients and Methods: We investigated cross-sectional data of n = 15,010 participants of the Gutenberg Health Study (GHS), a population-based, prospective, single-center cohort study in Mid-Germany (age 35 to 74 years). Noise annoyance was assessed separately for road traffic, aircraft, railways, industrial, neighborhood indoor and outdoor noise (“during the day”; “in your sleep”) on 5-point scales (“not at all” to “extremely”); depression and anxiety were assessed by the PHQ-9, resp. GAD-2.

Results: Depression and anxiety increased with the degree of overall noise annoyance. Compared to no annoyance, prevalence ratios for depression, respectively anxiety increased from moderate (PR depression 1.20; 95%CI 1.00 to 1.45; PR anxiety 1.42; 95% CI 1.15 to 1.74) to extreme annoyance (PR depression 1.97; 95%CI 1.62 to 2.39; PR anxiety 2.14; 95% CI 1.71 to 2.67). Compared to other sources, aircraft noise annoyance was prominent affecting almost 60% of the population.

Interpretation: Strong noise annoyance was associated with a two-fold higher prevalence of depression and anxiety in the general population. While we could not relate annoyance due to aircraft noise directly to depression and anxiety, we established that it was the major source of annoyance in the sample, exceeding the other sources in those strongly annoyed. Prospective follow-up data will address the issue of causal relationships between annoyance and mental health.

The effect of aircraft noise on sleep disturbance among the residents near a civilian airport: a cross-sectional study

Kyeong Min Kwak, Young-Su Ju, Young-Jun Kwon, Yun Kyung Chung, Bong Kyu Kim1, Hyunjoo Kim and Kanwoo Youn

Annals of Occupational and Environmental Medicine (2016) 28:38 DOI


(Kwak 2016)


Background: Aircraft noise is a major environmental noise problem. This study was conducted in order to investigate the relationship between sleep disturbance and exposure to aircraft noise on the residents who are living near an airport.

Methods: There were 3308 residents (1403 in the high exposure group, 1428 in the low exposure group, and 477 in the non-exposure group) selected as the subjects for this study. The Insomnia severity Index (ISI) and Epworth Sleepiness Scale (ESS) questionnaires were used to evaluate sleep disturbance.

Results: The mean ISI and ESS scores were 6.9, 6.4 and 5.5 ± 3.7, respectively, and the average scores were significantly greater in the aircraft noise exposure group, as compared to the non-exposure group. The percentage of the abnormal subjects, which were classified according to the results of the ISI and ESS, was also significantly greater in the noise exposure group, as compared to the control group. The odd ratios for insomnia and daytime hypersomnia were approximately 3 times higher in the noise exposure group, as compared to the control group.

Conclusions: The prevalence of insomnia and daytime hypersomnia was higher in the aircraft noise exposure group, as compared to the control group. Further study is deemed necessary in order to clarify the causal relationship.

Exposure-Response Relationship Between Aircraft Noise and Sleep Quality: A Community-based Cross-sectional Study

Kim, Chai, Lee, Park, Min, Kil, Lee, Lee.

Osong Public Health Res Perspect 2014 5(2), 108e114

(Kim 2014)


Objectives: Exposure to aircraft noise has been shown to have adverse health effects, causing annoyance and affecting the health-related quality of life, sleep, and mental states of those exposed to it. This study aimed to determine sleep quality in participants residing near an airfield and to evaluate the relationship between the levels of aircraft noise and sleep quality.

Methods: Neighboring regions of a military airfield were divided into three groups: a high exposure group, a low exposure group, and a control group. A total of 1082 participants (aged 30-79 years) completed a comprehensive self-administered questionnaire requesting information about demographics, medical history, lifestyle, and the Pittsburgh Sleep Quality Index.

Results: Of the 1082 participants, 1005 qualified for this study. The prevalence of sleep disturbance was 45.5% in the control group, 71.8% in the low exposure group, and 77.1% in the high exposure group (p for trend < 0.001). After adjusting for potential confounding factors, we determined the exposure-response relationship between the degree of aircraft noise and sleep quality. Of the participants with a normal mental status, the prevalence of sleep disturbance was 2.61-fold higher in the low exposure group and 3.52-fold higher in the high exposure group than in the control group.

Conclusion: The relationship between aircraft noise and health should be further evaluated through a large-scale follow-up study.

Environmental noise exposure, early biological risk and mental health in nine to ten year old children: a cross-sectional field study

Crombie, Clark and A Stansfeld.

Environmental Health 2011, 10:39

(Crombie 2011)


Background: Previous research suggests that children born prematurely or with a low birth weight are more vulnerable to the mental health effects of ambient neighbourhood noise; predominantly road and rail noise, at home. This study used data from the Road Traffic and Aircraft Noise Exposure and Children’s Cognition and Health (RANCH) study to see if this finding extends to aircraft and road traffic noise at school.

Methods: Children and their parents from schools around three European airports were selected to represent a range of aircraft and road traffic noise exposure levels. Birth weight and gestation period were merged to create a dichotomous variable assessing ‘early biological risk’. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). Complete data were available for 1900 primary school children.

Results: Children who were ‘at risk’ (i.e. low birth weight or premature birth) were rated as having more conduct problems and emotional symptoms and poorer overall mental health than children not at risk. However, there was no interaction between aircraft or road traffic noise exposure at school and early biological risk.

Conclusions: Data from the RANCH study suggests that children with early biological risk are not more vulnerable to the effects of aircraft or road traffic noise at school on mental health than children without this risk; however they are more likely to have mental ill-health.

The effect of aircraft noise exposure on long-term memory: a report of the Bangkok Airport Study

Miyakawa, Nuchpongsai, Matsui, Hiramatsu, Ekpanyaskul, Padungtod, Laemun

10th International Congress on Noise as a Public Health Problem (ICBEN) 2011, London, UK

(Miyakawa 2011)

Introduction: Previous studies suggest that aircraft noise exposure impairs cognitive performance such as reading, attention, and long-term memory (Evans et al. 1995, 1998; Haines et al. 2001a, 2001b; Hygge et al. 2002; Hiramatsu et al. 2003; Matsui et al. 2004; Stansfeld et al. 2005, 2010; Clark et al. 2006; Matheson et al. 2010). The Munich Airport Study (Evans et al. 1995, 1998; Hygge et al. 2002) was, for example, a longitudinal study conducted during the Munich Airport relocation to analyse the effect of aircraft noise exposure on cognitive function. The Munich Airport Study suggests that there might be a causal relationship between aircraft noise exposure and deficits in long-term memory and reading comprehension, and that these effects might be reversible.

Results: The comparison of the long-term memory scores obtained before and after the opening of the new airport showed that the long-term memory scores of the children in Suvarnabhumi did not become significantly higher (Wilcoxon signed rank test, p=0.182), whereas those of the children in the control group became significantly higher (Wilcoxon signed rank test, p<0.001). The long-term memory scores of the children in Don Muang also became significantly higher (Wilcoxon signed rank test, p<0.001), but the increase was lesser than in the control group.

Conclusions: A longitudinal study of the effects of aircraft noise exposure on long-term memory of primary school children was conducted in the area around the two airports in Bangkok, Thailand. As compared to the significant increase of long-term memory scores of the children in the control group, those of the children in Suvarnabhumi did not become significantly higher, whereas those of the children in Don Muang became significantly higher, but to a lesser degree. It seems reasonable to suppose that the increase in the long-term memory scores of the children in the control group was caused by their cognitive development and that aircraft noise exposure might have hindered the cognitive development of the children in Suvarnabhumi. We therefore conclude that aircraft noise exposure has adverse effects on long-term memory of primary school children.

Effects of Aircraft Noise on Noise Annoyance and Quality of Life around Frankfurt Airport

Dirk Schreckenberg & Markus Meis

IFOK GmbH – Institut für Organisationskommunikation, D-64625 Bensheim, Regional Dialogue Forum Frankfurt Airport, D-64625 Bensheim

(Schreckenberg 2007)

The Evaluation of Aircraft Noise Annoyance in the Frankfurt Airport Region as contracted by the Regional Dialogue Forum (RDF) includes:

  • Registering annoyance caused by air traffic in the Rhine-Main region while additionally collecting information on life satisfaction and health-related quality of life.
  • Measuring the extensity of aircraft noise annoyance at various times of day and night depending on the objective air traffic noise exposure.

This extensive study on noise effects revealed expected as well as unexpected results. It is by no means surprising that citizens residing in the Rhine-Main area feel disturbed and annoyed by air traffic noise. However, they are more annoyed and disturbed than mean values gathered for comparable populations in Hesse and the entire Republic of Germany dictate. Whereas according to the dose response-curve published in the EU position paper on dose-response relationships for noise annoyance (EG/WG2, 2002) 25% of residents are highly annoyed by aircraft noise at a noise level of Lden= 64dB(A), around Frankfurt Airport 25% are already highly annoyed at an aircraft noise level of Lden = 54 dB(A). This is in line with several other recently published European studies.

The evaluators recommend initiating an aircraft noise effect monitoring program in connection with an already planned monitoring of the socio-economic situation in the Rhine-Main area. Therewith, existing issues still in need of clarification would be approached and annoyance and quality of life measures could be tracked in their chronological trend. The points still open for discussion include:

  1. Changes in annoyance and disturbances due to aircraft noise should be monitored in the extension phases to come. A longitudinal monitoring program can examine whether annoyance adaptation processes as indicated in findings from the health monitoring program at the Amsterdam Schiphol Airport could be observed in the Rhine-Main population during the extension phase or not.
  2. The effect differences in aircraft noise measurements (Real Noise Distribution and 100/100 Rule) require more attention. Specific areas showing deviations should be observed.
  3. The relationship between annoyance and health-related effects needs to be causally clarified: Does chronic noise annoyance – not noise exposure – lead to further health impairments or do health impaired persons express greater noise annoyance? Vulnerable groups should especially be included in this investigation.

Whether periodically measuring aircraft noise effects with a social and aircraft noise monitoring program is possible in the Rhine-Main area, needs to be examined. If such a program is conveyed to the public as a prevention program, a positive stance towards trust in the airport expansion can be expected.

In summary, the reviewers recommend the RDF to draw the attention in further discussions on the effects of aircraft noise at Frankfurt Airport to the following points:

taking into account the specific situation at Frankfurt Airport with regard to the percentage of highly annoyance:

  • Considering the higher degree of annoyance at weekend and specific times of day (marginal hours during the day) with noise level constant.
  • Keeping in mind the well-known importance of active noise control relative to passive noise abatement measures like sound proof windows to ensure the possibility of poor disturbed outdoor stay.
  • Taking care of vulnerable residents (the elderly, multimorbid persons, noise sensitive persons).
  • Enforcing transparent information and risk communication to minimize gaps in population’s knowledge, and to assure trust in and credibility of authorities seen as responsible for aircraft noise reduction.
  • Monitoring the development in aircraft noise effects around Frankfurt Airport in line with the socio-economic situation of people in the Rhine-Main area. In this context: Evaluating the effectiveness and efficiency of technical noise abatement and communication measures. The effectiveness has to be definied not only in terms of reduction in noise exposure, but with regard to reduction of negative effects of noise on human being and improvements in residential situation and quality of life.

A review of health effects of aircraft noise

Morrell & Taylor, Aust LV Z J Public Health 1997; 21: 221-36

(Morrell 1997)


Social surveys have established dose-response relationships between aircraft noise and annoyance, with a number of psychological symptoms being positively related to annoyance. Evidence that exposure to aircraft noise is associated with higher psychiatric hospital admission rates is mixed. Some evidence exists of an association between aircraft noise exposure and use of psychotropic medications. People with a pre-existing psychological or psychiatric condition may be more susceptible to the effects of exposure to aircraft noise. Aircraft noise can produce effects on electroencephalogram sleep patterns and cause wakefulness and difficulty in sleeping. Attendances at general practitioners, self-reported health problems and use of medications, have been associated with exposure to aircraft noise, but some findings are inconsistent.

Some association between aircraft noise exposure and elevated mean blood pressure has been observed in cross-sectional studies of schoolchildren, but with little confirmation from cohort studies. There is no convincing evidence to suggest that allcause or cause-specific mortality is increased by exposure to aircraft noise. There is no strong evidence that aircraft noise has significant perinatal effects.

Using the World Health Organization definition of health, which includes positive mental and social wellbeing, aircraft noise is responsible for considerable ill-health. However, population-based studies have not found strong evidence that people living near or under aircraft flight paths suffer higher rates of clinical morbidity or mortality as a consequence of exposure to aircraft noise. A dearth of high quality studies in this area precludes drawing substantive conclusions.

[1] The complete list of references used in this report is available at: ICAO_Noise_White_Paper_2019-References.pdf