Objective To investigate the association of aircraft noise with risk of stroke, coronary heart disease, and cardiovascular disease in the general population.Design Small area study.Setting 12 London boroughs and nine districts west of London exposed to aircraft noise related to Heathrow airport in London.Population About 3.6 million residents living near Heathrow airport. Risks for hospital admissions were assessed in 12 110 census output areas (average population about 300 inhabitants) and risks for mortality in 2378 super output areas (about 1500 inhabitants).Main outcome measures Risk of hospital admissions for, and mortality from, stroke, coronary heart disease, and cardiovascular disease, 2001-05.Results Hospital admissions showed statistically significant linear trends (P<0.001 to P<0.05) of increasing risk with higher levels of both daytime (average A weighted equivalent noise 7 am to 11 pm, L Aeq,16h ) and night time (11 pm to 7 am, L night ) 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 (PM 10 ) 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. ConclusionHigh 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. IntroductionAlthough the literature on population annoyance associated with aircraft noise is extensive, 1 2 little research has been conducted on the potential effects of aircraft noise on cardiovascular health.2 Most studies of the health effects associated with aircraft noise have focused on blood pressure and the risk of hypertension. [3][4][5][6][7][8] The few reports of aircraft noise and risk of stroke, coronary heart disease, or cardiovascular disease are inconsistent, 9-12 partly reflecting reduced statistical power Noise levels show a graded, direct re...
Spatial epidemiology is increasingly being used to assess health risks associated with environmental hazards. Risk patterns tend to have both a temporal and a spatial component; thus, spatial epidemiology must combine methods from epidemiology, statistics, and geographic information science. Recent statistical advances in spatial epidemiology include the use of smoothing in risk maps to create an interpretable risk surface, the extension of spatial models to incorporate the time dimension, and the combination of individual- and area-level information. Advances in geographic information systems and the growing availability of modeling packages have led to an improvement in exposure assessment. Techniques drawn from geographic information science are being developed to enable the visualization of uncertainty and ensure more meaningful inferences are made from data. When public health concerns related to the environment arise, it is essential to address such anxieties appropriately and in a timely manner. Tools designed to facilitate the investigation process are being developed, although the availability of complete and clean health data, and appropriate exposure data often remain limiting factors.
Access and mobility are important dimensions of quality of life. For wheelchair users, everyday trips are often fraught with problems, with many barriers imperceptible to the able-bodied, hindering or totally restricting movement. This paper describes a project undertaken with wheelchair users, which has developed, tested and applied a Geographic Information System model. This model acts both as a navigational device for wheelchairs users -enabling them to make informed route choices through urban places -and as a decision support and planning tool for urban planners -making visible the ways in which built environments are often distorted and hostile spaces for wheelchair users.
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