Does aircraft noise exposure increase the prevalence of hypertension? Mediation and moderation analyses

Background Aircraft noise exposure seems to increase the risk of hypertension. Knowledge of the role of aircraft noise annoyance and noise-induced sleep disturbance in this potential effect is currently limited. This study aimed to assess the relationship between aircraft noise exposure and prevalent hypertension or elevated blood pressure, focusing on the mediating role of aircraft noise annoyance and sleep quality in this association. Additionally, it evaluated the moderating role of sex, age, and noise sensitivity. Methods We pooled data from the DEBATS and NORAH studies, conducted in France and Germany respectively. The present study thus involved 1,984 participants living near four major European airports in 2013. Aircraft noise exposure was estimated using validated noise maps in DEBATS and modelling based on radar flight trajectories in NORAH. Blood pressure measurements were recorded for all participants, who also completed a questionnaire on demographic and socio-economic factors, hypertension diagnosis, aircraft noise annoyance, sleep quality, medication use, and noise sensitivity. Mediation analyses were conducted using structural equation models, and moderation effects were examined through interaction analyses. Results In the pooled analysis, aircraft noise exposure tended to be positively associated with the prevalence of hypertension, but this relationship was not statistically significant in the adjusted model (OR = 1.08, 95% CI: 0.90, 1.29, for a 10 dBA increase in L den ). The indirect effect of aircraft noise exposure on the prevalence of hypertension through noise annoyance was statistically significant only in the NORAH study. Neither study found any indirect effect of night-time aircraft noise exposure on hypertension through impaired sleep quality. The effect of aircraft noise exposure on hypertension was higher in men and increased with age: it was significant in participants aged 65-74 and those over 74. No significant moderating role of noise sensitivity in the effect of aircraft noise exposure on hypertension was observed. Conclusion The results of this study support the moderating role of sex and age in the aircraft noise exposure effect on hypertension. The use of an additional multi-level noise annoyance measuring instrument and a physiological parameter for the objective characterization of sleep disturbances may be helpful in order to better understand the role of aircraft noise annoyance and sleep disturbances in the relationship between noise exposure and hypertension.