Environmental Pollution 316 (2023) 120605

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Environmental Pollution
journal homepage: www.elsevier.com/locate/envpol

Review

Environmental noise and health in low-middle-income-countries: A

systematic review of epidemiological evidence
Yingxin Chen a, b, *, Anna L. Hansell a, b, Sierra N. Clark c, Yutong Samuel Cai a, b
a
Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
b
The National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposure and Health at the University of Leicester,
Leicester, UK
c
Noise and Public Health, Radiation Chemical and Environmental Hazards, Science Group, UK Health Security Agency, UK

A R T I C L E I N F O A B S T R A C T

Keywords: Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income
Noise pollution countries, which has then been used to inform development of noise guidelines. It is unclear whether findings
Transportation noise in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs).
Health
We conducted this systematic review to summarise noise epidemiological studies in LMICs.
Developing countries
We conducted a literature search of studies in Medline and Web of Science published during 2009–2021,
supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well
as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation
Guide).
58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-
sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level
meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to
120 dB (Leq), with over half of the studies (52%) reporting the mean between 60 and 80 dB.
The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%)
and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between
noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise
exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental
health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had “probably low”, 18 (31%) had
“probably high” and 36 (62%) had “high” risk of bias. Quality of evidence was rated as ‘low’ for mental health
outcomes and ‘very low’ for all other outcomes. Strength of evidence for each outcome was assessed as ‘inade­
quate’, highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evi­
dence base.

1. Introduction et al., 2021), such as annoyance, restlessness, disturbance of activities,

nervousness, metabolic, and cardiovascular problems (World Health
Noise pollution, a consequence of humankind’s industrial, com­ Organization, 2018; World Health Organization, 2011), at levels below
mercial, transport-related, and recreational activities, has become a those that damage hearing. These cardiovascular and metabolic effects
serious public health concern in both developed and developing coun­ can result from both psychological and physiological distress (Nilsson,
tries, especially in urban areas (Banerjee, 2012; Argalášová-Sobotová 2018; van Kempen and Babisch, 2012; Münzel et al., 2021). Environ­
et al., 2013; van Kempen and Babisch, 2012). Exposure to high levels of mental noise may induce acute non-auditory effects directly by acti­
noise can induce hearing loss and tinnitus due to direct damage to the vating the autonomic nervous and endocrine systems via sub-cortical
auditory system. Over the last two decades, growing evidence has also interaction, and also indirectly through cortical arousal (Babisch, 2002).
shown that exposure to noise from transportation sources may also Noise-induced sleep loss in the long-term may interfere with the
result in non-auditory effects on health (Basner et al., 2014; Münzel over-production of stress hormones (e.g., cortisol), which could impact

* Corresponding author. Centre for Environmental Health and Sustainability, University of Leicester, Leicester, University Road, LE1 7RH, UK.
E-mail address: [email protected] (Y. Chen).

https://doi.org/10.1016/j.envpol.2022.120605
Received 30 June 2022; Received in revised form 14 October 2022; Accepted 3 November 2022
Available online 5 November 2022
0269-7491/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Y. Chen et al. Environmental Pollution 316 (2023) 120605

on health (Nilsson, 2018; van Kempen and Babisch, 2012; Smith et al., ng-groups, accessed Oct 11, 2022). Studies from countries and regions
2022). Noise annoyance may be a protective adaption strategy for by Gross National Income nominal (GNI) per capita classified in
human being to reducing the actual noise exposure and thereby low-income economies ($1045 or less), lower-middle-income economies
decreasing aggravating physical stress reactions (Nilsson, 2018; van ($1046 – $4095) and upper-middle-income economies ($4096 and $12,
Kempen and Babisch, 2012). 695) were included in this review (See Supplementary 1 for list of
There have been many reviews conducted to evaluate the epidemi­ countries).
ological associations of environmental noise with various health out­
comes ranging from cardiovascular to birth outcomes (World Health 2.1. Identification and selections of studies
Organization, 2018; Zare Sakhvidi et al., 2018, International Civil
Aviation Organization, 2019; Münzel et al., 2021; Smith et al., 2022; We conducted a search for epidemiological studies in LMICs focusing
Thompson et al., 2022b; Hegewald et al., 2020b; van Kamp et al., 2020). on environmental noise (including road traffic noise, railway noise,
In 2018, World Health Organization (WHO) published the “Environ­ aircraft noise, community noise, wind turbine noise, etc.) as exposure
mental Noise Guidelines for the European Region” based on a series of and its effects on health (including annoyance, cardiovascular disease,
commissioned systematic reviews of studies published up to 2015 mental health, etc.). Medline and Web of Science databases were used to
(World Health Organization, 2018). Notably, most of these studies were originally search published articles from January 1, 2009 and November
conducted in western and northern European countries. In addition, 4, 2019, which was later updated to November 10, 2021 (date of the
evidence of the health impacts from aircraft noise was completely drawn final search). We focused on studies in the last decade or so as to our best
from studies in high-income countries (HICs). While these reviews are knowledge this was the period when the evidence from LMICs started to
useful in the discussion of public health policies to control environ­ emerge. Detailed search strings for each electronic database are avail­
mental noise, it remains unclear whether such policies, primarily able in Supplementary 2. Additional efforts were made to search the
informed by studies in HICs, can be readily translated to bibliography in review papers and conference proceedings, as well as
low-middle-income-countries (LMICs). This concern is valid given that through our own reference libraries.
there exist substantial differences in terms of urban geographical, Study selection criteria are given in Table 1, following the PECO
socio-economical and demographical profiles between LMICs and HICs.
While common in high-income European and North American cities, Table 1
measuring and modelling environmental noise exposures at city-scale is Eligibility criteria to screen studies for the review.
still lacking in many LMICs, though some studies indicated that exposure
Components Inclusion criteria Exclusion criteria
levels may be elevated (Clark et al., 2022; Raess et al., 2021; Sieber
et al., 2017; Moroe and Mabaso, 2022; Debnath and Singh, 2018; Baloye Study type Epidemiologic studies were In-vitro, toxicological, animal,
included, e.g. ecological studies, or controlled exposure studies
and Palamuleni, 2015; Okokon et al., 2018). For example, Cai et al.,
cross-sectional studies, were excluded.
using simulation calculation methods to generate a traffic noise map of prospective and retrospective
Guangzhou, China (2013) found that noise levels were high during the cohort studies, case-control
day (Lday) (51.9% of the noise exceeded 50 dB; 6.56% of the noise over studies and observational or
experimental studies of people
70 dB) and night (Lnight) (52.1% of the noise exceeded 50 dB; 7.61% of
exposed to environmental noise.
the noise over 70 dB) (Cai et al., 2015). Furthermore, an extensive Population Members of the general Studies participants exposed to
measurement and land use regression (LUR) modelling study in Accra, population as well as specific occupational or laboratory-
Ghana found that almost the entire population living in the metropolitan segments of the population based noise were excluded.
area were exposed to environmental noise above 55 dB of Lden and 50 dB particularly at risk, such as
children or vulnerable groups.
of Lnight (Clark et al., 2022). These studies, while few, may indicate that
Eligible study participants are
city dwellers in some LMICs may be exposed to noise levels far exceeding those exposed to noise from
both international and national health-based guidelines, representing a home setting, traffic, and leisure
potential risk on the growing burden of non-communicable diseases in activities.
Study Eligible study conducted in Studies took place in other
LMICs. In the past 10 years, epidemiological evidence from LMICs has
location LMICs Country/regions, using countries or area were
slowly emerged to bridge this significant knowledge gap for world bank list https://datah excluded.
policy-making. However, a systematic review of such evidence has not elpdesk.worldbank.org/kno
been conducted to date. wledgebase/articles/90651
The aim of this systematic review is to present a timely synthesis of 9-world-bank-country-and-lendi
ng-groups).
studies on the epidemiological link between environmental noise
Exposure Both short- and long-term Studies participants exposed to
exposure and health outcomes in LMICs. The specific objectives of this environmental noise exposure occupational or laboratory-
review are to summarise (a) the relationships between short- and long- from road, rail, aircraft, based noise were excluded
term environmental noise exposure and mental or physical health out­ transport, industrial, wind
comes; (b) future research directions and policy perspectives in the turbine, construction and
communities. Noise exposure
context of LMICs. Occupational noise is out-of-scope in this review given levels was calculated and
its unique contexts in noise characteristics, exposure timeframe, exposed expressed in decibel (dB) values,
populations, health responses and policy regulations as compared to or on the basis of subjective
other forms of environmental noise. In fact, the WHO and the Interna­ ratings, that aimed to be
representative of the individual
tional Labour Organization (ILO) have recently reviewed occupational
exposure of the study
noise and health from studies in both HICs and LMICs (Teixeira et al., participants.
2021). Outcome Assessment of several health Health outcomes relating to
outcomes, including but not underlying biological
limited to, sleep, annoyance, mechanisms, e.g., epigenetics,
2. Methods
cognitive impairment, quality of metabolomics, methylation was
life, cardiovascular disease (e.g., excluded.
We followed the Navigation Guide methodology and criteria in ischemic heart disease,
conducting and reporting this review (Johnson et al., 2016). We defined hypertension, stroke), metabolic
“LMICs” using the World Bank 2021 list (https://datahelpdesk.worldba disease (e.g., obesity, diabetes
mellitus).
nk.org/knowledgebase/articles/906519-world-bank-country-and-lendi

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

(Population, Exposure, Comparator and Outcome) approach. The lead

author (YC) screened titles and abstracts against the eligibility criteria at
the first stage and read full texts of potentially eligible records at the
second stage. During the screening process, if there was question on
eligibility of any study, this was resolved through mutual discussion
with all authors.

2.2. Data extraction and preparation

A pre-designed standardized data extraction form in Microsoft Excel

was used to collect the following variables from each included study,
conducted by the lead author (YC): first author, publication year, study
design, study region, study population, population characteristics (age
and sex where available), exposure assessment (type), statistical anal­
ysis, confounders, investigated health outcomes, ascertainment of
outcome, key findings, and overall risk of bias (ROB).
There are three publications reporting on the same annoyance out­
comes based on the same population at the Hanoi Noi Bai International
Airport, Vietnam (Nguyen et al., 2020; Nguyen et al., 2018; Morinaga
et al., 2020). We only chose one of these publications (Nguyen et al.,
2020) with more waves of noise exposure data over the follow-up period
from 2014 to 2018.

2.3. Risk of bias evaluation in individual studies

Fig. 1. The selection process of the literature.

We followed the protocol for ROB assessment of individual studies
developed jointly by the WHO and ILO (Teixeira et al., 2019), which was
largely adapted from the Navigation Guide. The nine ROB domains are: reviews (N = 10), and our own references database (N = 9) which could
(1) source population representation; (2) exposure assessment; (3) not be found in Medline or Web of Science. Overall, 58 studies meeting
outcome assessment; (4) confounding; (5) blinding; (6) incomplete the eligibility criteria were included in the review.
outcome data; (7) selective outcome reporting; (8) conflict of interest
and (9) other sources of bias. For each of these domains, risk of bias was 3.2. Description of included studies
assigned to one of the five categories: low, probably low, probably high,
high, and not applicable. For criterion (4) confounding, we specified tier 1 The study characteristics of the 58 studies identified is shown in
(important) confounders as: age, sex, and socioeconomic status (SES) Fig. 2. All the studies were undertaken in 14 LMICs across Asia, Europe,
and tier 2 (other potentially relevant) confounder as tobacco smoking. Africa and the Americas. Most of the studies were conducted in India (N
We used the detailed instructions from the WHO/ILO protocol to assign = 13, 22.0%), followed by China (N = 10, 17%) and Bulgaria (N = 8,
rating to each domain for each study (Supplementary 3). Two authors 14%).
(YC + YSC) reviewed independently the full text of all included papers The study designs consisted of cross-sectional (N = 54, 92%), cohort
(and additionally SC reviewed for exposure assessment sections) guided (N = 3), ecological (N = 1) and case-crossover (N = 1) studies. The year
by the aforementioned instructions. Any disagreements were discussed with highest number of published studies was 2021 (N = 7) and the
and collectively decided and resolved. The overall ROB at study level lowest number of published studies (N = 3) were in 2011, 2012 and
was decided by the worst rating in any bias domain. 2017.
In terms of studied health outcomes, twenty-six (43%) studies
2.4. Quality and strength of evidence focussed on annoyance or perception, ten (17%) studies on cardiovas­
cular diseases, ten studies (17%) on mental health outcomes, four on
The overall quality and strength of evidence for each health outcome quality of sleep (7%), three (7%) on cognitive outcomes, two on hearing
was evaluated according to the Navigation Guide as detailed in (Johnson loss/deafness, one on Type 2 diabetes (T2DM), one on self-reported
et al., 2016). The lead author (YC) conducted an initial evaluation of body mass index (BMI), and one on health-related quality of life
quality and strength, and this initial evaluation was checked and revised (HRQOL).
by all authors following discussions. In brief, all studies were assumed to
be of a moderate quality and subsequently downgraded or upgraded 3.3. Exposure assessment techniques
according to set criteria (Supplementary 4); the overall quality of evi­
dence for each health outcome was then used in part to inform the The exposure assessment techniques present in the reviewed studies
overall strength of evidence (Supplementary 5). are shown in Fig. 3, and detailed information about the exposure
assessment methods used for each study are summarised in Supple­
3. Results mentary 7. Thirty-one (53%) studies assessed noise exposure based on
measurements with fixed-site sound level meters (SLM), ten studies
3.1. Search results (17%) used propagation-based model(s), five studies with self-reported
subjective rating, four with personal monitoring using SLMs, three used
The selection process of the literature is shown in Fig. 1. The liter­ both fixed -site SLM measurement and propagation-based model, three
ature search yielded 516 references. After screening the titles and ab­ used land used regression (LUR) models, and two assigned exposures by
stracts, we excluded 454 records. We went through 62 records in full- a proxy variable (i.e. living near a major road).
text assessment for eligibility listed in Table 1 where a further 23 re­ The mean level of noise exposure among all the reviewed studies
cords were excluded, details of papers excluded can be found in Sup­ ranged from 48.0 dB to 120.1 dB dB (Leq), with over half of studies (N =
plementary 6. A further 19 eligible studies were identified from existing 30, 51.7%) reporting mean noise levels of 60–80 dB in the study areas.

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

Fig. 2. Study characteristics (country, study design, health outcome and number of paper per year from 2009 to 21).

Fig. 3. Exposure assessment techniques used in the reviewed studies.

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

For bias due to noise exposure assessment, many of the measurement- (Song et al., 2016). All of them used logistic regression models. Noise
based studies (N = 29 out of 31) were rated as “high” or “probably was positively associated with likelihood of being highly annoyed,
high” risk because measurement protocols were not robust and/or they reaching statistical significance for all but one study (Trieu et al., 2021).
were deemed to lack the ability to capture sufficient spatial and/or Two studies focussed on aircraft noise in Ho Chi Minh City, Vietnam
temporal variations in study participant exposures. Conversely, the four found for 1 dB change in Lden, noise annoyance increased by 29.7% (95%
personal exposure studies from Beijing, China were rated as “low” ROB CI: 24.8%, 34.9%) (Nguyen et al., 2020) and 25% (95% CI: 20%, 31%)
for exposure as they were able to capture both spatial and temporal respectively (Trieu et al., 2021). One study, focussed on road traffic
variations in exposure and the time-activity patterns of each study noise in Belgrade, Serbia found noise annoyance increase by 3% (Odds
participant, which can influence exposure distributions. Eight out of 10 Ratio (OR): 1.03, 95% CI: 1.01, 1.05) per 1 dB (Leq) increased in daytime
studies based on propagation-based modelling were rated a “high” or noise level (Paunović et al., 2014). Another study in Yueyang, China
“probably high” ROB often because of limitations in, or lacking infor­ found the odds of being highly annoyed increased by 20.8% (95% CI:
mation on, input data (e.g., inclusion; spatial/temporal resolutions) 6%, 38%) for per 1 dB(A) increase of wind turbine noise in LAeq (Song
and/or a lack of model validation (i.e., with local measurements). The et al., 2016).
studies characterizing exposures based on subjective responses and by
proxy had ratings of “high” ROB due to the risk of exposure misclassi­ 3.5.2. Cardiovascular diseases (CVDs)
fication from recall bias, subjectivity, and/or lacking in accuracy, and This review identified 10 studies of associations of environmental
the three LUR studies were rated as “probably high”/“high” ROB. noise on CVDs (8 cross-sectional (Gilani and Mir, 2021; Lepore et al.,
2010; Paunovic et al., 2013; Banerjee et al., 2014a; Banerjee et al.,
3.4. Risk of bias assessment 2014b; Dzhambov et al., 2016; Farooqi et al., 2021; Hamid et al., 2019),
one case-crossover (Huang et al., 2013) and one ecological (Roca-­
In each of the nine ROB domains, for all studies, the majority of Barcelo et al., 2021). The detailed data extraction for these studies is
ratings were “high” or “probably high” (Table 2). The individual bias shown in Supplementary 9, Table 9.2.
assessment categories and rationale given for each study are included in Among these, overall ROB for one study was rated as “probably low”
Supplementary 8 (Table 8.1, 8.2, 8.3, 8.4, 8.5, and 8.6). There was the (Huang et al., 2013) and three studies were rated as “probably high” with
most potential for bias regarding exposure assessment (“probably high”/ less than three “probably high” ROB domains (Paunovic et al., 2013;
“high” ratings: N = 49), confounding (“probably high”/“high” ratings: N Gilani and Mir, 2021; Roca-Barcelo et al., 2021). There was the most
= 38) and population representative (“probably high”/“high” ratings: N potential for bias regarding exposure assessment (“high” ratings: N = 4;
= 36). Based on the worst rating in any bias domains in each study, there “probably high” ratings: N = 4). Two studies assessed noise exposure
were 36 (62.1%) studies with “high” ROB, 18 (31.0%) studies with based on propagation-based model (Gilani and Mir, 2021; Roca-Barcelo
“probably high” ROB, and 4 (6.9%) studies with “probably low” ROB. No et al., 2021), one based on fixed-site SLM measurement (Paunovic et al.,
studies were rated as having ‘low’ ROB. Among those 18 studies rated 2013), and the other used personal SLM monitoring (Huang et al.,
“probably high”, eight studies included a “probably high” rating in less 2013). In terms of statistical method, two studies used logistic regression
than three domains. models (Gilani and Mir, 2021; Roca-Barcelo et al., 2021)and two used
For each health outcome, we conducted a narrative synthesis of mixed linear models (Paunovic et al., 2013;Huang et al., 2013).
studies for which the overall ROB were rated as “probably low”, or Different cardiovascular outcomes were investigated among those four
“probably high” with less than three “probably high” rated across ROB studies, including heart rate variability (HRV) (Huang et al., 2013),
domains. coronary artery disease (CAD) (Gilani and Mir, 2021), cardiovascular
mortality in adults (Roca-Barcelo et al., 2021), and blood pressure (BP)
3.5. Health outcomes in children (Paunovic et al., 2013).
In the case-crossover study in Beijing, China, 40 young healthy adults
3.5.1. Annoyance and perception were asked to stay for 2 h in a traffic centre and a park in another
This review identified 26 studies of associations of environmental exposure scenario without moving for HRV measurement duration
noise with annoyance (One cohort study (Seabi, 2013) and 25 (Huang et al., 2013). This study found that for 1 dB(A) (LAeq) increase in
cross-sectional studies (Banerjee, 2013;Phan et al., 2010; Liu et al., noise, HRV indices significantly changed. Decrease of the percentage of
2017; Sieber et al., 2018; Wu et al., 2019; Nazneen et al., 2020Zamor­ differences between adjacent normal RR intervals that are larger than
ano-Gonzalez et al., 2021;Agarwal and Swami, 2010; Goswami, 2009; 50 ms (pNN50) and high frequency (HF) and increase of low-to-high
Song et al., 2016; Nandanwar et al., 2009; Agarwal and Swami, 2011; frequency power ratio (LFHFR) with changes of − 3.10% (95% CI:
Onchang and Hawker, 2018; Dias et al., 2021; Paiva et al., 2019; − 4.56%, − 1.62%), − 1.71% (95% CI: − 3.03%, − 0.36%), and 2.49%
Banerjee et al., 2009; Daruis et al., 2014; Firdaus and Ahmad, 2010; (95% CI, 1.14%, 3.85%), respectively (Huang et al., 2013). A study in
Guoqing et al., 2012; Paunović et al., 2014; Ristovska et al., 2009; Trieu India reported that residents living in noisy areas had a 2.25 (95% CI:
et al., 2021; Nguyen et al., 2020; Gjestland et al., 2015; Nguyen et al., 1.38, 3.67) times higher risk of CAD for 5 dB(A) increment in Lden (Gilani
2011), see Supplementary 9, Table 9.1). The studies were from India (N and Mir, 2021). One ecological study around Congonhas airport, Brazil
= 7), Vietnam (N = 5), China (N = 4), South Africa (N = 2), Brazil (N = assessed effects of aircraft noise exposure on cardiovascular mortality
2), and other countries. Risk of bias was rated as “probably high” for four (Roca-Barcelo et al., 2021). It was found that areas exposed to the
of these (Paunović et al., 2014; Song et al., 2016; Nguyen et al., 2020; highest levels of noise (>65 dB) showed a non-statistically significant
Trieu et al., 2021) and “high” for the remaining 22 studies. There was the relative risk (RR) for all CVD and coronary heart disease (CHD) mor­
most potential for bias regarding confounding (“high” ratings: N = 19) tality of 1.06 (95% CI: 0.94, 1.20) and 1.11 (95% CI: 0.96, 1.27)
because most studies only conducted simple correlation analysis (N = respectively, compared to those areas exposed to reference noise levels
10) without adjustment of some potential confounders. (≤50 dB) (Roca-Barcelo et al., 2021). One study in Belgrade, Serbia of
Among those four studies with “probably high” ROB, three defined 1113 children aged 7–11 years, measured noise level in schools (in the
participants who chose 8, 9, or 10 out of the 11-point numerical (0–10) day time) and in all 115 streets where children lived (in day and night
scale as “highly annoyed” following the International Commission on time) (Paunovic et al., 2013). This study also counted the number of
Biological Effects of Noise (ICBEN) method (Paunović et al., 2014; vehicles and assessed the presence of public transport by matching
Nguyen et al., 2020; Trieu et al., 2021) and the other one defined par­ children’s home and school addresses with public transport maps
ticipants who answered being “rather annoyed” and “extremely (Paunovic et al., 2013). Systolic blood pressure (SBP) was not signifi­
annoyed” as ‘highly annoyed” used a five-point verbal rating scales cantly associated with increases of noise levels, but children attending

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Table 2
Risk of bias assessment.
Study Source Exposure Outcome Confounding Blinding Incomplete Selective Conflict Other Overall
population assessment assessment outcome data outcome of sources of risk of
representation reporting interest bias bias

Annoyance
Paunović et al., 2014 PH PH PL PL L L L N/A PL PH
Song et al., 2016 L PL PL PH L L L L PL PH
Nguyen et al., 2020 PL PH PL PH L L L L PL PH
Trieu et al., 2021 PL PH PL PH L L L L PL PH
Agarwal and Swami, PH H H H L PH L N/A L H
2010
Goswami, 2009 H H H H L PH L N/A L H
Nandanwar et al., H H H H L PH L N/A L H
2009
Ristovska et al., 2009 PH H PL H L L L N/A L H
Banerjee et al., 2009 PH H H H L PH L N/A L H
Phan et al., 2010 PL H PL H L L L N/A L H
Firdaus 2010 H H H H L L L L L H
Agarwal 2011 PL H H H L PH L N/A L H
Nguyen et al., 2011 PL H PL H L L L N/A L H
Guoqing et al., 2012 PH H PL H L L L N/A L H
Seabi, 2013 PL PH PL H L L L L L H
Banerjee, 2013 PH H H PH L L L N/A L H
Daruis et al., 2014 PH H H H L PH L N/A L H
Gjestland et al., 2015 PL H PL H L L L N/A L H
Liu et al., 2017 PL PL PL H L L L N/A L H
Sieber et al., 2018 L H PL H L L L L L H
Onchang 2018 PH PH PL H L L L L L H
Wu et al., 2019 PL H H H L L L N/A L H
Paiva et al., 2019 PH PL H PL L L L N/A L H
Nazneen et al., 2020 PH H H PL L L L L L H
Zamorano-Gonzalez PH H H H L L L N/A L H
et al., 2021
Dias et al., 2021 PL H H H L L L N/A PL H
Cardiovascular outcomes
Huang et al., 2013 PL L L L L L L L PL PL
Paunovic et al., 2013 PH PL L PL L L L L PL PH
Banerjee et al., 2014a PH PH PH PL L L L L PL PH
Banerjee et al., 2014b PH PH PH PL L L L L PL PH
Dzhambov et al., PH PH PH L L L L L PH PH
2016b
Gilani and Mir, 2021 PL PL PH PL L L L L PL PH
Roca-Barcelo et al., L PH L PL L L L L L PH
2021
Lepore et al., 2010 PH H L PH L L L L PH H
Hamid et al., 2019 H H PH H L PH L L H H
Farooqi et al., 2021 H H PH H L PH L L H H
Mental health
Ma et al., 2020 L L PL L L L L L PL PL
Tao et al., 2020 L L PL L L L L L PL PL
Tao et al., 2021 L L PL L L L L L PL PL
Dzhambov et al., 2017 PH PH PL L L L L L PH PH
Dzhambov et al., PH PH PL L L L L L PH PH
2018a
Dzhambov et al., PH PH PL L L L L L PH PH
2018b
Dzhambov et al., 2019 PH PH PL L L L L L PH PH
Dzhambov 2014 PH H PL H L L L N/A PH H
Masoudzadeh et al., PH H PL H L L L N/A L H
2017
Ma et al., 2018 L H PL L L L L L PL H
Quality of sleep
Stošić et al., 2009 PH H PH H L L L N/A L H
Goswami et al., 2011 H H H H L PH PH N/A L H
Han et al., 2015 PL H PH H L L L L L H
Ravindra et al., 2016 PH PH PH H L L L N/A L H
Cognitive outcomes
Belojevic et al., 2012 PH PH PL PH L L L L L PH
Seabi et al., 2015 PL PH PL PH L L L N/A L PH
Seabi et al., 2012 PL PH PL H L L L N/A L H
Other outcomes
Dzhambov 2015 PH PH PH L L L L L PH PH
Dzhambov et al., PH PH PH L L L L L PH PH
2016a
Ana et al., 2009 PH PH PH H L PH L L L H
Siddiqui et al., 2015 H H PH H L PH L L L H
Ali et al., 2018 PH H PH H L L L L L H

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

school with public transport nearby had 1.3 mmHg (95% CI: 0.07, 2.58) Seabi et al., 2012). The detailed data extraction for these studies is
higher SBP compared to those without public transport nearby (Pau­ shown in Supplementary 9, Table 9.5. One study was rated as “high”
novic et al., 2013). Despite the heterogeneity of the outcomes investi­ overall ROB (Seabi et al., 2012), the other two were rated as “probably
gated, all four studies found a negative effect of noise on cardiovascular high” (Seabi et al., 2015; Belojevic et al., 2012), of which one study had
outcomes. less than three “probably high” rated across ROB domains (Seabi et al.,
2015). This particular study was conducted by the Road and Aircraft
3.5.3. Mental health outcomes Noise Exposure on Children’s Cognition and Health (RANCH-SA) lon­
This review identified 10 studies of associations of environmental gitudinal cohort study, which investigated the impact of environmental
noise on mental health outcomes (Tao et al., 2021; Dzhambov et al., noise, specifically aircraft noise, on primary school learners’ reading
2017; Masoudzadeh et al., 2017; Dzhambov and Dimitrova, 2014; comprehension. Noise exposure was assessed by fixed-site SLM mea­
Dzhambov et al., 2018b; Dzhambov et al., 2018a; Dzhambov et al., surement and reading comprehensive assessed with Suffolk Reading
2019; Ma et al., 2018; Ma et al., 2020; Tao et al., 2020), all of them were Scale Level 2.22. This study did not observe significant associations of
based on a cross-sectional design. The detailed data extraction for these noise effects with reading comprehension (Seabi et al., 2015). The
studies is shown in Supplementary 9, Table 9.3. Overall ROB was rated reading comprehension mean score of the low noise group (Leq: 50.5;
as “probably low” for three of these (Ma et al., 2020; Tao et al., 2020; Tao Mean ± SD: 43.52 ± 12.4) did not differ significantly (P > 0.16) from
et al., 2021), “probably high” (Dzhambov et al., 2017; Dzhambov et al., that of the high noise group (Leq: 55.2, Mean ± SD: 35.41 ± 15.7) in
2018b; Dzhambov et al., 2018a; Dzhambov et al., 2019) for four and 2010. There was also no statistically significant difference (P > 0.06)
“high” for the remaining three (Masoudzadeh et al., 2017; Dzhambov between the high noise group (Mean ± SD: 58.78 ± 17.2) and low noise
and Dimitrova, 2014; Ma et al., 2018). group (Mean ± SD: 46.29 ± 16.8) on reading comprehension in 2011.
All three studies with overall “probably low” ROB are from Beijing,
China and all assessed noise exposure based on personal SLM moni­ 3.5.6. Other outcomes
toring. Two studies assessed psychologic stress level by Geographic There were five studies investigating other health outcomes
Ecological Momentary Assessment (GEMA) which combined in­ including hearing loss (N = 2) (Siddiqui et al., 2015; Ana et al., 2009),
dividual’s GPS trajectories and psychological stress in real-time as health-related quality of life (HRQOL) (Ali et al., 2018), T2DM
delivered by GPS-equipped smartphone (Tao et al., 2020; Tao et al., (Dzhambov and Dimitrova, 2016), and BMI (Dzhambov and Dimitrova,
2021). Momentary stress levels were measured by asking participants 2015). The detailed data extraction for these studies is shown in Sup­
“How much stress do you experience now” on a 4-point scale (1 = little, 2 plementary 9, Table 9.6. All of them were based on cross-sectional study
= slight, 3 = moderate, and 4 = serious). Both studies reported that design. Overall ROB was rated as “probably high” for two (Dzhambov and
noise was associated with increased momentary stress levels. One study Dimitrova, 2016; Dzhambov and Dimitrova, 2015) (with more than
found that with each additional increase of one standard deviation (SD) three “probably high” across ROB domains) and “high” ROB for the
of measured noise level (12.0 dB LAeq), the momentary stress level remaining three studies.
increased by 7.2% (95% CI: 5.8%, 8.6%) (Tao et al., 2020). The other
study found that per inter-quartile increase in noise (LAeq), it was posi­ 3.6. Overall quality & strength of evidence
tively associated with momentary stress levels although not statistically
significant (OR = 1.15; 95% CI: 0.95, 1.56, IQR = 7.98 dB) (Tao et al., We evaluated the overall quality of evidence separately for each
2021). One study assessed mental health by asking the question: “In health outcome using the eight criteria in the Navigation Guide. We
general, how would you evaluate your mental health status over the past few assessed the evidence related to mental health to be of “low” quality; the
weeks?” The responses were quantified on a 5-point Likert scale ranging quality of evidence for all other examined health outcomes to be “Very
from 1 (very poor) to 5 (very good). This study found that noise was low”. The most common reasons for downgrading the quality of evidence
negatively associated with residents’ self-reported mental health (Ma were due to the “risk of bias” and “imprecision” criteria for differing risk
et al., 2020). Individual-level noise exposure based on their space-time estimates and wide confidence intervals (see Table 3, Supplementary 10
behaviours over a 24-h period (Leq,24h) was significantly associated and 11 for details). Similarly, we rated the overall strength of evidence
with residents’ self-reported mental health, in both weekday (− 0.93, of harmfulness to be “Inadequate” for all health outcomes.
95% CI: − 1.85, − 0.02) and weekend models (− 1.89, 95% CI: − 3.39,
− 0.38) (Ma et al., 2020). 4. Discussion

3.5.4. Quality of sleep 4.1. Summary of findings

This review identified only four studies of associations of environ­
mental noise on quality of sleep in LMICs. The detailed data extraction To our knowledge, this is the first review on the health impacts of
for these studies is shown in Supplementary 9, Table 9.4. The studies environmental noise in LMICs. Overall, we identified 58 studies pub­
were from India (N = 2), China (N = 1) and Serbia (N = 1), all of them lished between 2009 and 2021 that met the inclusion criteria. Among
were based on a cross-sectional design. All these studies reported the studies identified, the most frequently investigated outcomes
adverse effects of noise on sleep quality (Stošić et al., 2009; Han et al., included annoyance, cardiovascular health and mental health. Most of
2015; Ravindra et al., 2016; Goswami et al., 2011), however, all of them these studies were of cross-sectional design, conducted with relatively
were rated as having overall “high” ROB. There was the most potential small sample sizesand assessments of exposure were often deemed to
for bias regarding confounding (“high” ratings: N = 4) because all studies have a high risk of exposure misclassification. Collectively, most studies
conducted simple correlation analysis. In terms of definition of sleep were deemed to have an overall high risk of bias. This has largely limited
quality, one studied assessed sleep quality by Pittsburgh Sleep Quality our ability to draw conclusions from the current evidence base.
Index (PSQI) (Han et al., 2015), one used questionnaire constructed Nonetheless, several lines of evidence appear to be consistent with
following the ICBEN method (Ravindra et al., 2016), one used 5-point that reported from previous studies, conducted in mostly HICs. For
Likert scale (Stošić et al., 2009) and one did not provide detail on how example, studies in LMICs generally have reported a positive association
sleep quality was assessed (Goswami et al., 2011). between noise exposure and annoyance, with higher levels of noise
contributing to a higher proportion of the population being highly
3.5.5. Cognitive outcomes annoyed. Among the extremely limited number of studies on CVD out­
This review identified three studies of associations of environmental comes, it was reported that short-term noise exposure may slightly in­
noise on cognitive outcomes (Seabi et al., 2015; Belojevic et al., 2012; crease blood pressure in children in Serbia and long-term noise exposure

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

Table 3
A summary of the quality and strength assessments.
Health outcome Quality criteria Overall Strength
quality
Risk Indirectness Inconsistency Imprecision Publication Large Dose- Residual
of bias magnitude of response Confounding
bias effect Increases
Confidence

Annoyance and − 2 0 0 − 1 0 0 0 0 Very low Inadequate

perception evidence of
harmfulness
Cardiovascular − 2 0 − 1 − 1 0 0 0 0 Very low Inadequate
outcomes evidence of
harmfulness
Mental health − 1 0 0 − 1 0 0 0 0 Low Inadequate
evidence of
harmfulness
Quality of sleep − 2 0 0 − 1 0 0 0 0 Very low Inadequate
evidence of
harmfulness
Cognitive − 2 − 1 − 1 − 1 0 0 0 0 Very low Inadequate
outcomes evidence of
harmfulness
Others − 2 0 0 − 1 0 0 0 0 Very low Inadequate
evidence of
harmfulness

was linked to higher prevalence of hypertension or CAD in adults in by 12% per 10 dB Lden (RR: 1.12, 95% CI: 1.02, 1.23). In contrast, the
India. Studies on all other outcomes remain limited, which precluded a meta-analyses of road (11 studies) and railway traffic noise (3 studies)
meaningful synthesis of the findings. indicated 2–3% (not statistically significant) increases in depression risk
per 10 dB Lden (Hegewald et al., 2020a). Our findings from the three
studies with overall “probably low” ROB from China are consistent with
4.2. Comparison with previous reviews and the WHO commissioned
those from the previous reviews that there is low-quality evidence for a
reviews
harmful effect of road traffic noise on self-reported mental health or
stress and rated the overall strength of evidence of harmfulness to be
There are two reviews for LMICs which summarised evidence at the
“Inadequate”.
country level, including a 2012 meta-analysis of residential road traffic
For quality of sleep, the 2018 WHO review reported an OR for the
noise and annoyance in an Indian sub-population (Banerjee, 2012) and a
percent highly sleep disturbed for a 10 dB increase in Lnight for aircraft
2011 narrative review on environmental noise effects on cardiovascular
(1.94; 95% CI 1.61, 2.3), road (2.13; 95% CI 1.82, 2.48), and rail (3.06;
outcomes in Serbia (Belojevic et al., 2011). The Serbian review included
95% CI 2.38, 3.93) noise (Basner and McGuire, 2018). Our review was
five studies all published pre 2009 (Belojevic et al., 2011). The Indian
not able to draw any conclusions in LMICs based on the four identified
review summarised the evidence from 1991 to 2009 and found
cross-sectional studies, which were rated as having high overall ROB.
long-term noise exposure to road traffic noise may be associated with an
For cognition, the 2018 WHO review did not provide a quantitative
increased risk of annoyance (Banerjee, 2012). Our review provides an
estimate but indicated evidence of moderate quality for an association
important update on the latest progress made in the research area of
between aircraft noise and reading comprehension: of the 14 studies
noise and health in a much wider LMICs context.
reviewed, 10 demonstrated a statistically significant association be­
For annoyance, the systematic review supporting the 2018 WHO
tween higher aircraft noise exposure and poorer reading comprehension
Environmental Noise Guidelines for the European Region (the 2018
(Clark and Paunovic, 2018a). An updated review found moderate
WHO review hereafter) identified 62 studies mostly from HICs (Guski
quality evidence for an association between aircraft noise and reading
et al., 2017). The review reported a correlation between road traffic
and language in children, and moderate quality evidence against an
noise levels and annoyance raw scores (r = 0.325; p < 0.001; from 21
association between aircraft noise and executive functioning in children
studies) and OR for % highly annoyed -increase per 10 dB increase of
(Thompson et al., 2022a). The present review only found one study from
noise level (50 dB vs. 60 dB Lden) (summary OR = 2.74, 95% CI: 1.88,
South Africa but with a “probably high” overall ROB, in which a signif­
3.99; p < 0.001; from 12 studies). Our findings from the four studies
icant association was not found with aircraft noise on the reading
with “probably high” ROB from Vietnam, Serbia, and China are largely
comprehension.
consistent with those from the WHO review, with the percentage of
populations being highly annoyed increasing with higher levels of noise.
For hypertension, the 2018 WHO review reported a relative risk (RR) 4.3. Exposure assessment
of 1.05 (95% CI: 1.02, 1.08) per 10 dB (Lden) increase of road traffic
noise (Van Kempen et al., 2018). Direct comparisons cannot be made The reviewed noise epidemiological studies from LMICs largely
between our review and the WHO review because only one study with focused on noise from road-traffic sources, while a few studies focussed
an overall ROB rating of “probably high” measuring BP levels in children on noise from aircraft or noise in community settings, one on con­
and one study with an overall ROB rating of “probably high” using struction noise, and one study focused on noise from wind turbines. No
self-reported hypertension were available in LMICs. studies considered leisure noise. As well, all studies characterized
For mental health, there were no quantitative estimates from either average noise levels rather than noise frequency or peak levels.
the 2018 WHO review (Clark and Paunovic, 2018b) or from a more The majority of the reviewed studies from LMICs used measurement-
recent updated review (Clark et al., 2020a). Both reviews concluded that based approaches to characterize exposures. Within large-scale epide­
there was low-quality evidence for a harmful effect of road traffic noise miological studies in Europe (Khan et al., 2018), however, it has been
on measures of depression and anxiety. One recent meta-analysis of five common to derive exposures from propagation-based noise modelling,
aircraft noise studies found that depression risk increased significantly which is based on the mathematical description of source emissions and

8
Y. Chen et al. Environmental Pollution 316 (2023) 120605

propagation of sound through the environment. While these models can Barrington-Leigh and Millard-Ball, 2017), and can be implemented in
provide accurate and source-specific noise estimates over large areas, cost-effective ways (Clark et al., 2020b).
they are also resource intensive and require detailed and accurate data Among the reviewed studies, we found mean levels of noise exposure
on noise emissions (e.g., traffic volume, speed, fleet composition) and ranging from 48.0 dB to 120.1 dB dB (Leq). Over half of the studies (N =
factors affecting sound propagation, such as: building geometry, mate­ 31, 52.5%) reported a mean noise level ranging from 60 to 80 dB in the
rials, and density; road surface; as well as meteorology (Khan et al., study areas. We also compared the exposure range from the 2018 WHO
2018). As such, this may hinder their implementation in some LMICs reviews and the present review (See Supplementary 12). Many studies in
where national governments or international corporations do not our review recorded elevated mean noise levels (range 55–80 dB Lden, N
routinely collect the relevant input data, and at spatial and temporal = 17), exceeding road-traffic noise health-based guidelines set by the
resolutions useful for epidemiological applications (Clark et al., 2022; WHO at 53 dB (Lden). Some studies around airports recorded aircraft
Raess et al., 2021; Sieber et al., 2017). Furthermore, limitations in input noise ranging from 44 to 81 dB (Lden), exceeding the WHO guideline
data can result in large errors in exposure estimates. The application of level for aircraft noise at 45 dB (Lden). One study for wind turbine noise
propagation-based noise models was uncommon (N = 10 studies) in the ranged from 44.8 to 50.4 dB (LAeq) while WHO guideline level for wind
LMICs studies we reviewed, and 8 were rated as having a “high” or turbine noise is set at 45 dB (Lden). It is possible that environmental noise
“probably high” ROB with regards to exposure assessment, largely pollution is likely more severe in some LMICs cities, where vehicle
because of limitations in, or lacking information on, input data (e.g., movement and fleet composition, exposure pattern, road geometry and
inclusion; spatial/temporal resolutions) and/or a lack of stated model conditions, noise standards, and mixtures of other community sources,
validation (i.e., with local measurements). However, the increasing can be contrastingly different from those in HICs; however, the exposure
availability of publicly available global datasets (e.g., building foot­ data from the reviewed studies is too limited and heterogeneous to make
prints (Microsoft Open Source, 2022); Google traffic data), coupled with firm conclusions against the WHO guideline values.
advancements in data/signal processing to generate new data (e.g.,
computer vision techniques applied to satellite and street-view imagery 4.4. Strength, limitations and future research directions
to detect road, roof, and façade characteristics (Weichenthal et al.,
2019)) could help expand the use of propagation-based noise models in Methodologically, the value of our review lies in the wide-ranging
LMICs settings, and do so in a way that models are locally and contex­ systematic search strategy, the updated timeframe (2009–2021), the
tually relevant. range of health outcomes considered, as well as the quality assessment of
Fixed-site measurements can be suitable for exposure assessment in included studies. This review provides a comprehensive picture of the
epidemiological studies if accurate measurements are collected which breadth and quality of noise effects on health studies in LMICs.
are also representative of the exposure time frame of interest and cap­ This review is subject to several limitations. First, it was a challenge
ture variability of exposures across space and study participants (Staab conducting a unified ROB assessment for a pool of studies with hetero­
et al., 2022). However, many of the reviewed studies evaluating chronic geneous study designs, exposure assessments, and health outcomes, and
health outcomes and conditions collected a limited number of some of our ROB assessment ratings may be sensitive to the ROB
short-term measurements (i.e., 10 min–24 h), without repeat at the same assessment tool used. We also had to rely on the information given
locations on different days. This contributed to an assignment of “high” within each paper, and if critical details were missing, this would affect
ROB in relation to exposure as measured exposures may not be repre­ the ROB assessment as we did not discuss directly with each author due
sentative of longer-time scales. Furthermore, some of the to the volume of reviewed studies. Also, there is a possibility of publi­
measurement-based studies had a low number of sites (<10) relative to cation bias, i.e., there are chances that papers have been left out, if they
the study area size, it was sometimes unclear if sites were appropriately have not been published in journals or conference proceedings due to
sampled, and how exposures were assigned to study participants living reasons such as null findings. Also, we only included studies written in
nearby. In contrast, studies using personal exposure measurements English, some of the literature from LMICs written in other languages
collected with wearable devises were rated as “low” ROB as they, by may have been missed, which could have biased our results. Quantita­
design, capture exposure variations across space, but also individual tive meta-analyses were not possible for this review given the unsuit­
time-activity patterns that influence daily exposures (Steinle et al., ability and limitations of the available data from these reviewed studies
2013). in LMICs.
Measurement-based approaches are often not logistically feasible for Noise pollution, as evidenced in our review, is likely impacting many
application in large-scale epidemiological studies (e.g., city/country- cities in LMICs. However, its public health impacts are often overlooked
scale). Though, they can be used to validate propagation-based by the environmental health research community. We advocate that
models, or to build and validate statistical-based models, such as land more high-quality epidemiological studies using robust and represen­
use regression (LUR) (Khan et al., 2018), which can predict exposures tative exposure assessment methods and population-based cohorts and/
across large areas at unmeasured locations and at refined spatial scales. or electronic health records should be conducted, as well as well-
We found that only three studies in our review used LUR approaches, designed interventional studies (Brown and Van Kamp, 2017). Evi­
and due to limitations in the temporal/spatial resolution of input mea­ dence from these studies would assist local policymaking and actions in
surements (Dzhambov et al., 2018a; Dzhambov et al., 2019) and model LMICs to reduce environmental noise exposures and reap substantial
validation (Sieber et al., 2018), all were rated as “high” and “probably public health benefits.
high” ROB. However, many other noise LUR models developed for cities
in Europe, North America, and Asia have achieved high predictive ac­ 5. Conclusion
curacies (e.g. (Liu et al., 2020; Walker et al., 2016; Aguilera et al., 2015;
Harouvi et al., 2018; Ragettli et al., 2016; Staab et al., 2022; Wang et al., To our knowledge, this is the first review to summarise current evi­
2016) and LUR models have also recently been successfully developed dence on the relationships between environmental noise exposures and
for other LMICs cities, such as in Dalian (China) (Xie et al., 2011), Sao health outcomes in LMICs. Despite the majority of the overall ratings for
Paulo (Brazil) (Raess et al., 2021), and Accra ((Ghana) (Clark et al., ROB assessments were “high” or “probably high”, we were able to gather
2022). LUR models based on robust measurements may be an attractive some evidence on annoyance and physical health outcomes such as
method for scaling up noise exposure assessment in epidemiological cardiovascular health. Meta-analyses were not possible as studies on a
studies in LMICs settings as they can capture noise from a diversity of given health outcome were either too heterogeneous or too few. This
sources, leverage increasingly available global GIS predictor variable review has provided a critical analysis on important knowledge gaps for
datasets (Microsoft Open Source, 2022; Brown et al., 2022; the noise and health research community in LMICs to address in the near

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Y. Chen et al. Environmental Pollution 316 (2023) 120605

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vided inputs on literature search and interpretation of the literature. executive functioning in urban primary school children: the moderating role of
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Declaration of competing interest Brown, C.F., Brumby, S.P., Guzder-Williams, B., Birch, T., Hyde, S.B., Mazzariello, J.,
Czerwinski, W., Pasquarella, V.J., Haertel, R., Ilyushchenko, S., 2022. Dynamic
The authors declare that they have no known competing financial World, Near real-time global 10 m land use land cover mapping. Sci. Data 9, 1–17.
Cai, M., Zou, J., Xie, J., Ma, X., 2015. Road traffic noise mapping in Guangzhou using GIS
interests or personal relationships that could have appeared to influence and GPS. Appl. Acoust. 87, 94–102.
the work reported in this paper. Clark, C., Crumpler, C., Notley, A.H., 2020a. Evidence for environmental noise effects on
health for the United Kingdom policy context: a systematic review of the effects of
environmental noise on mental health, wellbeing, quality of life, cancer, dementia,
Data availability birth, reproductive outcomes, and cognition. Int. J. Environ. Res. Publ. Health 17.
Clark, C., Paunovic, K., 2018a. WHO environmental noise guidelines for the european
No data was used for the research described in the article. region: a systematic review on environmental noise and cognition. Int. J. Environ.
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Clark, C., Paunovic, K., 2018b. WHO Environmental noise guidelines for the European
Acknowledgement Region: a systematic review on environmental noise and quality of life, wellbeing
and mental health. Int. J. Environ. Res. Publ. Health 15, 2400.
Clark, S.N., Alli, A.S., Brauer, M., Ezzati, M., Baumgartner, J., Toledano, M.B., Hughes, A.
We acknowledge support from National Institute for Health Research F., Nimo, J., Moses, J.B., Terkpertey, S., 2020b. Protocol: high-resolution
(NIHR) Health Protection Research Unit in Environmental Exposures spatiotemporal measurement of air and environmental noise pollution in sub-
and Health, a partnership between UK Health Security Agency, the saharan African cities: pathways to equitable health cities study protocol for Accra,
Ghana. BMJ Open 10.
Health and Safety Executive and the University of Leicester. The views Clark, S.N., Alli, A.S., Ezzati, M., Brauer, M., Toledano, M.B., Nimo, J., Moses, J.B.,
expressed are those of the author(s) and not necessarily those of the Baah, S., Hughes, A., Cavanaugh, A., 2022. Spatial modelling and inequalities of
NHS, the NIHR, the Department of Health and Social Care or the UK environmental noise in Accra, Ghana. Environ. Res. 214, 113932.
Daruis, D.D.I., Awang, N.W., Deros, B.M., Ismail, A.R., 2014. The effects of night-time
Health Security Agency (UKHSA). road traffic noise on discomfort-A case study in Dungun, Terengganu, Malaysia. Iran.
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township area – a mathematical based approach. Appl. Acoust. 129, 161–172.
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org/10.1016/j.envpol.2022.120605. perceptions in a Brazilian metropolis: BH Health Study. Revista brasileira de
epidemiologia = Brazilian journal of epidemiology 24, e210038.
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