1. Recent health impact research in Denmark
Mette Sørensen
Senior researcher
Diet, Genes and Environment
Danish Cancer Society Research Center
Denmark
Present some of the results from the more recent studies we have conducted in my research group at the….

2. ? Traffic noise and health Hypertension Ischemic heart disease Stroke
Obesity
Diabetes
Atrial fibrillation
Heart failure
Cancer ?
As most of you know there has been a number of studies on…

3. Traffic noise and health
Obesity
Diabetes
Atrial fibrillation
Heart failure
Cancer
Potential biological mechanisms
Epidemiological studies (noise/sleep/stress)
Design of our study
Results of our study
As most of you know there has been a number of studies on…

4. Mechanisms, obesity/diabetes
Traffic noise
Stress response:
autonomic nervous
system and HPA axis
Disturbance of sleep
(duration, quality)
Cortisol
Metabolic disease – focus on obesity and diabetes
↓ Insulin levels
↓ Insulin sensitivity
↓ Glycose tolerance
↑ Morning glucose
↓ Leptin (satiety)
↑ Ghrelin (hunger)
Obesity, diabetes

5. Obesity and diabetes Epidemiological studies on sleep disturbance:
Short sleep duration -> obesity in children
Reduced sleep quality and duration -> waist circumference and BMI in adults
Reduced sleep quality and quantity -> increase risk of diabetes
Meta-analysis: 10 prospective studies, > 100,000 participants, 3,500 diabetes cases
Traffic noise and obesity
Two Swedish studies -> an association between traffic noise and obesity (Pyko et al; Eriksson et al)
One study suggest no association (Oftedal et al)

6. Study population Diet, Cancer and Health cohort Enrolment in 1993-1997
57,053 persons aged years
Copenhagen and Aarhus
Questionnaire
Lifestyle: e.g. diet, smoking, alcohol
SES: e.g. education
Weight, height and waist circumference measured

7. National registries Long tradition for registers in Denmark
Personal identification number (PIN) -> all Danes at birth
Reporting to registers by law -> almost complete
Generally high validity of registers
Central Population Registry (1971)
all present and historical addresses from
The National Patient Registry (1977) - all hospital submissions
The National Diabetes Registry (1995)
The Cancer Registry (1942)

8. Noise exposure, road and rail
SoundPLAN – the Nordic Prediction Method
Geocode and height (floor) for each address ( )
Building polygons
All road lines with > 1000 vehicles
Traffic composition (heavy/light)
Yearly average daily traffic
Traffic speed
All railway links
Annual average daily train lengths
Train types and travel speed
Noise barriers
AirGIS – dispersion model for estimation of air pollution

9. Obesity, results Design Results for road traffic noise
BMI, waist circumference, fat percentage of 57,000 persons (50-64 y)
Long-term residential road traffic noise
Adjusted for age, sex, and socioeconomic factors
Results for road traffic noise
↑ BMI
↑ waist circumference
↑ fat percentage
Christensen et al, 2015

10. Traffic noise and diabetes
Sørensen et al, 2013, Denmark
Cohort study: 57,053 participants
3,869 diabetes cases from national register
RESULTS
10 dB rise in 5-years mean road traffic noise
11 % increase in risk (IRR: 1.11 ( ))

11. Atrial fibrillation and heart failure
Abnormal heart rhythm -> rapid and irregular beating
Increased cardiovascular morbidity and mortality
10 % at age 80 years
Prevalence rising
Heart failure
Complex syndrome -> end-stage of other CVD
Weakened heart muscle -> not enough blood to meet body's needs
Most frequent reason for hospitalization among older people

12. Mechanisms, AF and heart failure
Traffic noise
Stress response:
autonomic nervous
system and HPA axis
Disturbance of sleep
Impaired immune system
Cortisol
Hypertension, IHD
Endothelial dysfunction
↑ glycogen concentration within atrial myocytes
Changes of atrial
electrophysiology
Systemic inflammation
Atrial fibrillation, heart failure

13. Traffic noise and atrial fibrillation
Monrad et al, 2016, Denmark
Cohort study: 57,053 participants
Long-term road traffic noise (5-years mean)
2,692 persons developed A-fib (national register)
RESULTS
10 dB rise in 5-years mean road traffic noise
6 % increase in risk (IRR: 1.06 ( ))
adjustment for air pollution reduced estimate
(difficult to separate association from exposure to air pollution)

14. Traffic noise and heart failure
Sørensen et al, submitted
Cohort study: 57,053 participants
Long-term road traffic noise (10-years mean)
2,550 persons developed heart failure (national register)
RESULTS
10 dB rise in 10-years mean road traffic noise
14 % increase in risk (IRR: 1.14 ( )) before air pollution
8 % increase in risk (IRR: 1.08 ( )) after air pollution
MI, diabetes, hypertension, chronic obstructive pulmonary disease

15. Cancer Breast cancer Prostate cancer Non-Hodgkin’s lymphoma
originating from lymphoid tissue

16. Impaired immune response / inflammation
Mechanisms, cancer
Traffic noise
Stress response:
autonomic nervous
system and HPA axis
Disturbance of sleep
(duration, quality)
↑ Cortisol
Circadian rhythm disruption
↓ Apoptosis
↑ Angiogenesis
↓ Melatonin
Impaired immune response / inflammation
↓ DNA repair
↑ Estrogen
↓ Antioxidant
Oxidative stress
Cancer

17. Breast cancer Sørensen et al, 2014 Cohort study: 30,000 women
Long-term road traffic AND railway noise (5-years mean)
1,219 women developed breast cancer (national register)
Estrogen receptor: 858 positive/203 negative cases
Adjustment: Parity, age first birth, HRT, lifestyle, SES

18. Breast and prostate cancer
Breast cancer: Sørensen, 2014
Road and railway: no association with ER positive BC
Among ER negative BC:
Road: IRR = 1.23 ( )
Railway: IRR = 1.38 ( )
Prostate cancer: Roswall, 2015
1,457 cases from national register
No associations with road traffic or railway noise

19. Non-Hodgkin’s lymphoma
Well-established risk factor -> suppression of immune system
Sørensen et al, 2015
Case-control study (all Denmark): 2,753 cases / 4,743 controls
Long-term residential road traffic noise
Adjusted for sex, age and SES
Traffic noise
Cases
Adjusted
OR (95% CI)
Road traffic noise, 5-y
< 55 dB
1,103
1.00
55-65 dB
1,256
0.98 ( )
≥ 65 dB
394
1.18 ( )

20. Conclusions Diabetes and obesity “Novel” major cardiovascular diseases
road traffic noise associated with diabetes
we and others find traffic noise to be associated with obesity
“Novel” major cardiovascular diseases
association between road traffic noise and atrial fibrillation
association between road traffic noise and heart failure

21. Conclusions
Cancer
road traffic and railway noise associated with estrogen receptor negative breast cancer
road traffic noise not associated with prostate cancer
road traffic noise above 65 dB associated NHL
MORE STUDIES ARE NEEDED
OVERALL CONCLUSION
Research suggests that traffic noise is associated with other major diseases than IHD, stroke and hypertension

22. Thank you for your attention