SOER 2015 Implementation Plan Presented at the 18 th EIONET Air Quality Meeting
Meeting of the Eionet National Reference Centres for Noise Copenhagen, 14 th - 15 th October 2009...
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Transcript of Meeting of the Eionet National Reference Centres for Noise Copenhagen, 14 th - 15 th October 2009...
Meeting of the Eionet National Reference Centres for NoiseCopenhagen, 14th - 15th October 2009
Linking Exposure To Health
Wolfgang Babisch
Martin van den Berg
European Environment AgencyExpert Panel on Noise (EPoN)
European Environment Information and Observation Network
Calm NetworkVision for the Year 2020
Source: CALM, 2004
“Avoid harmful effects of noise exposure from all sources and preserve quiet areas.”
Community Research Strategy Plan
Coordination of European Research for Advanced Transport Noise Mitigation
WHO Constitution (1948):
Health is a state of complete physical mental and social well-being
and not merely the absence of disease or infirmity.
Health
Sound level
Annoyance
Noise sensitivity
Other factors
Health
Sound level
Annoyance
Noise sensitivity
Other factors
Health
Well-being and Ill-health
Introduction
Health endpoints
Exposure-response curves
Risk assessment
Cost-benefit analysis
Implications for END
References
Expert Panel on Noise (EPoN)Fact Sheet
Fact-sheet on Noise Exposure andPotential Health Impact
Introduction
Health endpoints
Exposure-response curves
Risk assessment
Cost-benefit analysis
Implications for END
References
Expert Panel on Noise (EPoN)Fact Sheet
Fact-sheet on Noise Exposure andPotential Health Impact
Hazard identification
Exposure-response assessment
Exposure assessment
Risk characterizationAttributable risk concept
Risk managementRegulatory options
Quantitative Risk Assessment
END ?Link
Research !
Hearing loss
Annoyance
Sleep disturbance (objective and subjective)
Cognitive impairment
Mental health
Physiological stress reaction
Cardiovascular risk
Health Endpoints"Hazard Identification"
Source: Miedema and Oudshoorn, 2001European Commission Working Group on Dose-Effect Relations, 2002
0
10
20
30
40
50
60
70
80
35 40 45 50 55 60 65 70 75 80
Noise level (Lden, 24h) [dBA]
Pe
rce
nt
hig
hly
an
no
ye
d (
HA
) [%
] Aircraft
Road
Railway
25%-Criterion
Common rule
WHO Community Noise Guidelines (1999):
"Serious annoyance"
Annoyance "Highly Annoyed"
Aircraft noise
0
10
20
30
40
50
60
70
80
40 45 50 55 60 65 70 75
Lden (aircraft noise) [dB(A)]
Pe
rce
nt
hig
hly
an
no
ye
d [
%]
Miedema Total GB D NL S
Δ = 7-8 dB(A)
0
10
20
30
40
50
60
70
80
40 45 50 55 60 65 70 75
Lden (road traffic noise) [dB(A)]
Pe
rce
nt
hig
hly
an
no
ye
d [
%]
Miedema Total GB D NL S
Road traffic noise
Change of Annoyance "Hyena Study"
Source: Babisch et al., 2009
Annoyance Due To Aircraft NoiseUpdate
"Little annoyed" "Highly annoyed""Annoyed"
Source: TNO, 2009
Older studies
Older studies
Older studies
Newer studiesincluded
Newer studiesincluded
Newer studiesincluded
Sleep
Normal sleep
Noise disturbed sleep
Source: Maschke et al., 2000
Sleep Disturbance (Objective)Awakenings (Single Aircraft Flyover) – "DLR Laboratory Study"
(Changes to wake or to sleep-stage S1 within 90 seconds)
Maximum Sound Pressure Level LAS,max [dB]
Source: Basner et al., 2006
Pro
babi
lity
of s
leep
sta
ge c
hang
es to
aw
ake
Spontaneous awakening
Noise induced awakening
33 dB
Sleep Disturbance (Objective)Aircraft Noise Simulation – "DLR Field Study"
Source: Basner and Griefahn, 2008
Moderate Effects in
Vulnerable Groups
Steep Increase of
Adverse Effects
Public Health Hazard
Lnight, outside (aircraft)Figure 1: The average number of additionally aircraft noise induced awakenings per night. Altogether, 10 million 8-hour nights with 1 to 200 (1, 2, 3,…, 200) noise events randomly drawn from the DLR field study 20 were simulated. The lines represent (from below to above) 2.5, 25, 50, 75, and 97.5 percentiles. In an 8 h undisturbed night of a healthy sleeper, on average 24 spontaneous EEG awakenings (as defined by Rechtschaffen and Kales1) can be observed (equaling 8,760 spontaneous awakenings per year).
365 EEG awakenings per year
• Noise and transient sleep disturbance - well developed area with statistically robust data and dose-response relationships.
• No quantitative link yet established between acute or transient sleep disturbance caused by noise and any long term adverse health effects.
• No consensus on any single dose-response relationship which could be used to inform cost benefit analysis, monetary evaluation of adverse health effects, policy etc.
Sleep Disturbance Health (?)
Source: Bell report, 2009Griefahn and Basner (Internoise), 2009
Cross-sectional study, 1718 males and females, aged 18-90 yrsRelative prevalence of treated high blood pressure by road traffic noise level
0
1
2
3
4
< 60 60 - 65 > 65
Lday,16h [dB(A)]
Od
ds
Rat
io
0
1
2
3
4
< 50 50 - 55 > 55
Lnight,8h [dB(A)]
Od
ds
Rat
io
Significant effects only with respect to the exposure of the bedroom
OR = 1.9
Day - Living room Night - Bedroom
Source: UBA - Maschke et al. (2003)
Hypertension"Spandau Health Survey"
0
5
10
15
20
25
30
35
35 40 45 50 55 60 65 70 75 80Noise level (Lnight) [dBA]
Per
cen
t h
igh
ly s
leep
dis
turb
ed (
HS
D)
[%]
Aircraft
Road
Railway
5%-Criterion (?)
WHO Community Noise Guidelines (1999):
"Sleep disturbance, window open"
Source: Miedema and Oudshoorn, 2001European Commission Working Group on Health and Socio-Economic Aspects, 2004
Sleep Disturbance (Subjective) "Highly Sleep Disturbed"
WHO Night Noise Guidelines For Europe (2009):
"Night noise guideline"
Source: Hygge et al., 2002
no noise
noise
Difficult word list, 326 children
Old airport
Wave 1 Wave 2 Wave 3
Old airport closed
0
1
2
3
4
5
6
7
8
9
10
Me
an
err
ors
Mea
n er
rors
New airport
0
1
2
3
4
5
6
7
8
9
10
Me
an
err
ors
Wave 1 Wave 2 Wave 3
New airport opened
Mea
n er
rors
Cognitive Impairment"Munich Study"
Source: Stansfeld et al., 2005
-.2
0.2
.4R
eadi
ng Z
-sco
re
30 35 40 45 50 55 60 65 70aircraft noise dB(A)
2844 children
Reading Comprehension"Ranch Study"
Aircraft noise at school LAeq,16h [dB]
Aircraft noise associated with deficits in reading comprehension and recognition memoryR
eadi
ng Z
-sco
re
NoiseWorking memory
Episodic memory
Read
Listen
Phonological loop
Visual loop
Basic Memory ModelRead – Listen - Learn
It could be noted that:
Both chronic noise exposure in the field study and acute noise exposure in the experiments impair episodic memory, in particular recall.
There is a strong similarity in how much and in what way children and adults are affected by noise.
Staffan Hygge
Source: Hygge, 2009 (presentation in Helsinki)
Ldn
0
2 0
4 0
6 0
8 0
1 0 0
4 0 4 5 5 0 5 5 6 0 6 5 7 0 7 5 8 0 8 5 9 0 9 5 1 0 0
L d n
Per
cen
t af
fect
ed
L d n
Assuming that 100% of the noise exposed are cognitively affected at a very high noise level, e.g. 95 Ldn, and that none are affected at a safely low level, e.g. 50 Ldn, a straight line (linear
accumulation) connecting these two points, as in the Figure below can be used as basis for approximation.
Hypothetical Exposure-Response Curve- Cognitively Affected -
Source: Hygge, 2009 (presentation in Helsinki)
Staffan Hygge
No evidence
Mental Health
v. Kamp and Davies (2008):
"... there is no direct association between environmental noise and mental health". "Noise annoyance is consistently found to be an important mediator."
Clark and Stansfeld (2007):
"Overall, studies suggest that both adults and children noise exposure is probably not associated with serious psychological illness, but there may be effects on well-being and quality of life."
Source: Bell report, 2009
Source: Henry & Stephens, 1977PerceivedStimulus
Coping PatternsEarly Experience
Genetics
Fight - Flight
Nervous System + Adrenaline + Noradrenaline o Cortisol
Hypophysis (Pituitary Gland) + ACTH + Cortisol o Catecholamines
Depression
Threat to Control Loss of Control
Sympathetic-Adrenal-Medullar Axis Hypophysio-Pituitary-Adrenal-Cortical Axis
Stress Model
Cross-sectional study, 195 females, aged 30-45 yrsOvernight excretion of norepinephrine in urine by road traffic volume
Mean +/- SE
20
21
22
23
24
25
26
<14,000 (mean = 2,300) >20,000 (mean = 31,000)
Traffic volume [vehicles/day]
Noradrenalineper Creatinine
[µg/g]
Source: Babisch et al. (2001)
LAeq,24h < 60 dB LAeq,24h > 65 dB
Stress Hormones"Berlin Traffic and Health Study"
- With respect to environmental noise acute noise effects occur, in particular, when certain activities such as concentration, relaxation or sleep are disturbed.
- Even subjects that have been living for many years in exposed homes show physiological stress reactions.
- During sleep no complete habituation takes place. Even subjects who are subjectively disturbed by the noise show acute physiological reactions to single noise events.
Figure: Maschke, 2004
Habituation / Adaption
Sound exposure
Disturbance ofintended activities
Stress indicators
Biologicalrisk factors
Cardiovasculardiseases
Noise Exposure (Sound Level)
Direct pathway Indirect pathway
Hearing loss
Disturbance of activities, sleep communicationCognitive and
emotional response
Annoy-ance
Autonomic nervous system (sympathetic nerve)Endocrine system (pituitary gland, adrenal gland)
Cardiovascular DiseasesHypertension Arteriosclerosis Ischaemic heart diseases
Stress Indicators
Risk Factors
Blood pressure Blood lipids Blood viscosityCardiac output Blood glucose Blood clotting factors
Manifest Disorders
Physiological stress reactions (homeostasis)
Simplified Noise Reaction Model
Source: Babisch, 2002
-0.2
-0.1
0
0.1
0.2
0.3
0.4
51-55
56-60
61-65
66-70
51-55
56-60
61-65
66-70
Traffic Noise Level [dB(A)]
Re
lati
ve
ch
ole
ste
rol l
ev
el
[mm
ol/l
]
+ SE
Mean
- SE
Caerphilly Speedwell
Cross-sectional study, 4860 males, aged 45-63 yrsRelative concentration of serum cholesterol by road traffic noise
Source: Babisch et al., 1993
Traffic noise level Lday,16h [dB(A)]
Serum Cholesterol"Caerphilly & Speedwell Studies"
Cross-sectional study, 4860 males, aged 45-63 yrsRelative concentration of plasma viscosity by road traffic noise
-0.01
-0.005
0
0.005
0.01
0.015
0.02
0.025
0.03
51-55
56-60
61-65
66-70
51-55
56-60
61-65
66-70
Traffic Noise Level [dB(A)]
Re
lati
ve
pla
sm
a v
isc
os
ity
lev
el
[cp
] + SE
Mean
- SE
Caerphilly Speedwell
Traffic noise level Lday,16h [dB(A)]
Source: Babisch et al., 1993
Plasma Viscosity"Caerphilly & Speedwell Studies"
Source: Babisch, 2006
0.6
0.8
1
1.2
1.4
1.6
1.8
Lday [dB(A)]
Od
ds
rati
o
Caer+Speed
Berlin I
Berlin II
Berlin III
Pooled
Traffic noise level Lday,12hr [dB(A)]
Heterogeneity: p = 0.943
Exposure-Response Curve: Myocardial InfarctionMeta-Analysis: Road Traffic Noise
5 studies
Source: Babisch, 2006, 2008
Exposure-Response Curve: Myocardial InfarctionMeta-Analysis: Road Traffic Noise
Traffic noise level Lday,12hr [dB(A)]
Re
lati
ve
ris
k (
od
ds
ra
tio
)
Ischaemic Heart Disease
Exposure-response function: OR = 1.629657 – 0.000613*(Lday,16h)2 + 0.000007357*(Lday16h)3, R2 = 0.96OR per 10 dB(A) = 1.17, 95% CI = 0.87-1.57, range = 60-80 dB(A)
pooled(5 studies)
Source: Babisch und van Kamp, 2008
Exposure-response function: OR per 10 dB(A) = 1.13, 95% CI = 1.00-1.28, range = 50-70 dB(A)
Exposure-Response Curve: HypertensionMeta-Analysis: Aircraft Noise
0.8
1
1.2
1.4
1.6
1.8
2
2.2
45 50 55 60 65 70 75
Aircraft noise level approx. Ldn [dB(A)]
Re
lati
ve
ris
k Amsterdam
Stockholm1
Okinawa
Hyena
Stockholm2
pooled(5 studies)
Heterogeneity: p = 0.002
Hyena study, 4861 subjects, age 45-70 yrsRelative prevalence of hypertension by road traffic noise
0.190 0.928 0.829-1.038
0.031 1.141 1.012-1.286
P = 0.044 OR pro 10 dB(A) = 1.097 CI = 1.003-1.201
0.550 1.021 0.953-1.095
0.037 1.101 1.006-1.205
0.068 1.071 0.995-1.154
0.041 1.099 1.004-1.202
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
<47.5 47.5-52.4 52.5-57.4 57.5-62.4 62.5-67.4 >=67.5
LAeq24h - road [dB(A)]
Od
ds r
ati
o +
/- 9
5%
CI
Source: Jarup et al., 2008
Road Traffic Noise - Hypertension"Hyena Study"
Hazard identification
Exposure-response assessment
Exposure assessment
Risk characterizationAttributable risk concept
Risk managementRegulatory options
Quantitative Risk Assessment
Link
Annoyance
Sleep disturbance (subjective)
Cognitive impairment (children)
Cardiovascular
Established Exposure Response Relationships
Population attributable risk
Impact fraction
AF = {(Pi * RRi) - 1} / (Pi * RRi)
where: Pi = Proportion of the population in exposure category i RRi = relative risk at exposure category i compared to the reference level
Attributable FractionFormula
7-19 year old children
Noise exposure level Ldn
No. of children exposed *
% who will develop noise-induced cognitive impairment
N with noise-induced cognitive impairment per year
< 55 68% 1 012 817 0 0
55-65 19% 282 993 20 56 599
65-75 11% 163 838 50 81 919
> 75 2% 29 789 75 22 342
Total 100% 1 489 437 160 859
Attributable Fraction: Cognitive ImpairmentExample: Sweden, Children
Source: Hygge, 2009 (presentation in Helsinki)
Staffan Hygge
* Approximation: European exposure distribution considered for Sweden (Roovers et al., 2000)
Moyocardial Infarction (MI) Caused By Traffic Noise
Reference year 1999
Average sound pressure level
during the day (6-22 h)
Lday,16hr [dB(A)]*
Percentage exposed
[%]
Relative risk of myocardial infarction
[OR] *)
<= 60 69.1 1.000
>60 – 65 15.3 1.031
>65 – 70 9.0 1.099
>70 – 75 5.1 1.211
>75 1.5 1.372
Attributable fraction: 2.9%
Germany 1999:
MI: 133,115 cases
IHD: 849,557 cases
Attributable Fraction: Myocardial Infarction / IHDExample: Germany, Adults
* Probabilistic model
Due to road traffic noise:
3,900 MI cases/year
24,700 IHD cases/year
MI = Myocardial infarctionIHD = Ischaemic heart diseases
Source: Babisch, 2002 (WHO 1992 - modified)
Severity vs. Population Affected
Mortality
Disease(sleep disturbance,
cardiovascular)
Stress Indicators(autonomous response, stress hormones)
Risk factors(blood pressure, cholesterol,
blood clotting, glucose)
Feelings of discomfort(annoyance, disturbance)
Number of people affected
Source: de Hollander et al., 2001, 2004
Life expectancy: mortality, morbidity, loss of healthy life-years
Quality of life: severe feelings of discomfort, reduced ability to concentrate, unfavourable health perception and stress in relation to poor quality of the local environment
Social magnitude: number of people affected
DALYsDisability Adjusted Life Years
Idea: Quantification UnitOne figure to aggregate different effects of different severity
Priority settingDALYs as a public health currency?
Cost-benefit analysisMonetary valuation of external costs and benefits (DALYs vs. QUALYs)
DALY = YLL x YLDYLL = ND (number of deaths) x DW (disability weight) x LD (standard life expectancy at age of death in years)YLD = NI (number of incident cases) x DW (disability weight) x LI (average duration of disability in years)
Severity weight factors (disability weights)Ethics (dependent on cultural weighing systems), who decides (experts)?
DALYs
Mortality = 1.000
Non-fatal acute myocardial infarction = 0.406 (WHO)
Ischaemic heart disease = 0.350 (de Hollander, 1999)
High blood pressure = 0.352 (Mathers, 1999)
Primary insomnia = 0.100 (WHO, 2007)
Sleep disturbance = 0.020 (Knol, 2005); 0.055 (Müller-Wenk, 2005)
Annoyance = 0.010 (Stassen, 2008); 0.033 (Müller-Wenk, 2005)
Cognitive impairment = 0.006 (Hygge, 2009)
Disability WeightsDALYs
Disability weights that have been used
Noise exposure levelLden
No. exposed population
< 40 3 %
40-50 17 %
50-60 56 %
> 60 24 %
Total 100 %
Attributable Fraction: AnnoyanceExample: DALYs Per Year For The Netherlands
Source: Knol and Staatsen, 2005
Reference year 2000
Exposure distribution ('Empara')
Noise source DALYs per million people per reference year
Road 1122
Air 16
Rail 65
Total 1203
"Severe" annoyance('Miedema' curves)
Adults:Disability weight DW = 0.020
Example:Severe
annoyanceNetherlands
Severe sleep disturbance Netherlands
Cognitive effectsSweden
Ischaemic heart diseasesGermany
Subjects Adults Adults Children 7-19 yrs Adults
Total population Ca. 14 Mio Ca. 14 Mio Ca. 1.5 Mio Ca. 70 Mio
Exposure Empara Empara EU estimate Probabilistic UBA
Reference year 2000 2000 2000 1999
Disability weight 0.02 0.02 0.006 0.350
DALYs per Million of people
1203 591 648 361
DALY Examples
Economic ValuationExample: Switzerland
Source: Swiss Federal Office for Spatial Development, 2004, 2008
Exposure Assessment
Environmental Noise Directive, Noise Mapping
Which purpose?
- Identification of hot spots (exposure)
- Public health (affected population in general)
- Action plans
- Regulatory (limit values)
- Epidemiological study (individual exposure)
Shielding: Terraced HousesLday,12 h
Distance from the road (meters)Source: Lercher et al. (2000)
Exposed Side: High Blood Pressure"Inn Valley Study"
Proximity to road, room orientation
Pro
po
rtio
n w
ith
hy
per
ten
sio
n
Source: Lercher et al, 2000
Modifiers of Exposure: Windows"Inn Valley Study"
Systolic blood pressure
Prospective study, 3950 men, aged 45-63 yrsExtreme group comparison: LAeq,day = 66-70 dB(A) vs. 51-55 dB(A)
Relative incidence of major ischaemic heart diseases
Source: Babisch et al. , 1999
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2
2.25
2.5
Addressonly
+ Windoworientation
+ Openwindow
+ 15 yrsresidence
Inc
ide
nce
od
ds
rati
o(O
R +
/- 9
5% C
I)
Exposure Misclassification"Caerphilly & Speedwell Studies"
Environmental Noise Directive(Directive 2002/49/EG)
Phase 1 until 30.06.2007» Major road network > 6 Mio vehicles per year» Major railway network > 60.000 trains per year» Major airports > 50.000 aircraft movements per year» Major agglomerations > 250,000 inhabitants» Action plans until 2008
Phase 2 until 30.06.2012» Major roads > 3 Mio vehicles per year» Major railway tracks > 30.000 trains per year» Agglomerations > 100,000 inhabitants» Action plans until 2013
Augsburg Noise Maps House At A Close Distance To A Major Road
City Map ("RLS90") END Map ("VBUS")
Software: Cadna
Augsburg Noise MapsHouse At A Close Distance To A Major Road
City Map
Software: Cadna
Front / back sideLday, 16h: 70/50 dB(A)Δ = 20 dB(A)
END Map
Front / back sideLday, 12h: 67/44 dB(A)Δ = 23 dB(A)
Augsburg Noise MapsHouse At A Far Distance To A Major Road
City Map END Map
Software: Cadna
Augsburg Noise MapsHouse At A Far Distance To A Major Road
City Map
Software: Cadna
Front / back sideLday, 16h: 62/46 dB(A)Δ = 16 dB(A)
END Map
Front / back sideLday, 12h: 44/43 dB(A)Δ = 1 dB(A)
Exposure-response relationships are available
Methods for quantitative risk assessment are established
Applicable for general noise policies and action planning ("what happens - if" scenarios)
DALYs for combining effects (?)
Economic valuation for decision making (?)
Exposure assessment must be comprehensive
END underestimates the true exposure
Conclusions
Contact:
“Calling noise a nuisance is like calling smog an inconvenience”(W. H. Steward, former Surgeon General of USA)
Thank You For Listening
Cardiovascular: Lday ≤ 65 dB(A)
Serious annoyance: Lday ≤ 55 dB(A)
Moderate annoyance: Lday ≤ 50 dB(A)
Cardiovascular: Lnight ≤ 55 dB(A)
Sleep disturbance: Lnight ≤ 45/40 dB(A)
Outdoors
Environmental Noise Quality Targets
» Short-termPrevention of health riskLden = 65, Lnight = 55
» IntermediateReduction of serious annoyance Lden = 60, Lnight = 50
» Long-term Avoidance of serious annoyance Lden = 55, Lnight = 45
UBA Quality Targets"Federal Environment Agency, Germany"
Coherence (biological plausibility)
Consistency with other studies in different populations and with different methodology
Presence of dose-response relationship
Magnitude of effect
Even small relative risks may be relevant for public health
Epidemiological Reasoning
Cross-sectional study, 195 females, aged 30-45 yrsOvernight excretion of nor-epinephrine in urine by road traffic volume
Source: Babisch et al., 2001
20
21
22
23
24
25
26
27
28
29
30
Low (categories 1+2+3) High (categories 4+5)
Sleep disturbance
No
rad
ren
aln
e [µ
g/g
Cre
atin
ine]
Windows open
Windows closed
Subjects had controlover the stimulus
Subjects had no control over the noise
Coping: Stress Hormones"Berlin Traffic And Health Study"