PROCEEDINGS of the
23rd International Congress on Acoustics
9 to 13 September 2019 in Aachen, Germany

Aircraft noise exposure and saliva cortisol in a pooled-analysis fromseven European countries
Clémence BAUDIN1, Marie LEFÈVRE1,2, Jenny SELANDER3, Wolfgang BABISCH4, Ennio
CADUM5, Marie-Christine CARLIER6,7, Patricia CHAMPELOVIER8, Konstantina
DIMAKOPOULOU9, Danny HUITHUIJS10, Jacques LAMBERT7,8, Bernard LAUMON11, Göran
PERSHAGEN12, Töres THEORELL13, Venetia VELONAKI14, Anna HANSELL15, Anne-Sophie
EVRARD11Univ Lyon, Université Claude Bernard Lyon1, IFSTTAR, UMRESTTE, UMR T_9405, Bron, France
2
3

Now at: Technical Agency for Information on Hospital Care, Lyon, FranceInstitute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
4

Currently retired, Berlin, Germany (formerly Federal Environment Agency)
5

6

Environmental Health Unit, Agency for Health Protection, Pavia, Italy

Hospices Civils de Lyon GH Sud CBAPS Laboratoire de Biochimie, Pierre Bénite, France
7

8

Currently retired, France

IFSTTAR, Planning, Mobilities and Environment Department, Dynamics of Mobility Changes Team,Bron, France
9Department of Hygiene, Epidemiology and Medical Statistics Faculty of Medicine, National andKapodistrian University of Athens, Athens, Greece
10National Institute of Public Health and Environmental Protection, Bilthoven, the Netherlands
111213

Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

Stress Research Institute, Faculty of Social Sciences, Stockholm University, Sweden
1415

IFSTTAR, Transport, Health and Safety Department, Bron, France

Nurses School, National and Kapodistrian University of Athens, Athens, Greece

Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UKABSTRACT
The HYENA (HYpertension and Exposure to Noise near Airports) study, a well-known study on thehealth effects of aircraft noise, involved 4,861 participants from six European countries (except France). The
DEBATS (Discussion on the health effects of aircraft noise) study, a study with a similar protocol, included
1,244 participants from France. Associations were found between aircraft noise and cortisol levels in eachstudy separately, but they were not consistent between the two studies.
The objective of the present study was to combine both datasets in order to improve statistical power.
We investigated the associations between aircraft noise levels and cortisol levels in the morning and in theevening, and the relative variation per hour, adjusted for relevant confounders. Analyses were carried out on
the 1,300 participants with complete information for cortisol samplings and for confounders.
We found evidence for an increase in the evening cortisol level in women (exp(β)=1.09, 95%CI:1.01;1.18), and for flattening of the relative variation per hour also in women (exp(β)= 0.90, 95%CI:0.840.97), with a Lden 10-dB(A) increase. There were no significant associations in men.
These findings provide some support for a psychological stress induced by aircraft noise exposure,
resulting in disruption of hormonal rhythms.
Keywords: aircraft noise exposure, cortisol levels, Europe1539

1. INTRODUCTION
Many studies have evidenced adverse effects of aircraft noise exposure on health, such asannoyance, cardiovascular diseases, sleep disorders or altered cognitive performance (1–6). The
precise mechanisms underlying noise-induced health physiological effects would imply release ofstress hormones with noise exposure (7). Although they were widely discussed, the effects of noise
exposure including occupational, road, railway and air traffic noise on cortisol secretion are still
unclear. The conclusions of the largest epidemiological studies to date about the associations between
aircraft noise exposure and cortisol levels are inconsistent (8,9). On one hand, the HYENA(HYpertension and Exposure to Noise near Airports) study, including 439 participants, suggests that
exposure to aircraft noise increases morning saliva cortisol levels in women, but no similar association
was found in men (8). On the other hand, the DEBATS study (Discussion on the health effects ofaircraft noise), including 1,244 participants, observed an increase in evening cortisol levels and aflattening of the usual variation per hour when aircraft noise exposure increased, but in that study no
difference were shown between gender subgroups (9).
The objective of the present study was to combine data collected in both HYENA andDEBATS studies in order to improve statistical power, and provide a pooled-analysis of these twolargest studies to date.

2. METHODS
2.1 Study population
The HYENA study included randomly-selected 4,861 participants between 45-70 years of age at
the time of the interview and living near one of the seven major European airports [London Heathrow(United Kingdom), Berlin Tegel (Germany), Amsterdam Schiphol (the Netherlands), Stockholm
Arlanda and Bromma (Sweden), Milan Malpensa (Italy), and Athens Eleftherios Venizelos (Greece)
Airports]. Then, nearly 500 participants with the highest and lowest levels of exposure to aircraft noisein each country were selected for saliva sampling. Among them, 439 participants had complete
information on their cortisol levels.
The DEBATS study included randomly-selected 1,244 participants over 18 years of age at the timeof the interview and living near one of the three French airports (Paris-Charles de Gaulle,
Lyon-Saint-Exupéry and Toulouse-Blagnac). Among them, 1,199 participants had complete
information on their cortisol levels.
Participants from both studies responded to a similar questionnaire administered by an interviewer
at their place of residence. The questionnaire collected in particular demographic and socio -economic
information, lifestyle factors such as smoking and alcohol consumption, and personal medical history.
The final pooled analyses were carried out on N = 1,300 participants (359 from HYENA and 941
from DEBATS, including 555 men and 745 women) who had completed information for all thecovariates included in the final model.
2.2 Cortisol measurements
All the participants received a kit with test tubes and instructions. Participants were requested tocollect a saliva sample 30 min (in HYENA) (corresponding usually to the peak in cortisol
concentration) or immediately (in DEBATS) after awakening, and another one just before going to bed
in the evening (which usually coincides with the nadir in cortisol concentration).
Cortisols levels were then determined by the Spectria cortisol coated tube radioimmunoassay kit(Orion Diagnostica, Espoo, Finland) in HYENA, and by cortisol saliva ELISA kit in DEBATS (IBLinternational, Hamburg, Germany).
2.3 Aircraft noise exposure assessments
Exposure to aircraft noise was estimated with a 1-dB(A) resolution at the place of residence of theparticipants, in front of their buildings, and were provided by the INM (Integrated Noise Model) (10)for almost all the countries of the study. Only the UK used another model, the national Aircraft NoiseContour Model (ANCON v 2) (11), similar to the INM model.

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Four noise indicators were derived and used in the statistical analyses: L den, LAeq24h, LAeq6h-22h, andLnight .
2.4 Confounders
The major potential confounders were obtained from the questionnaire. They were a priori includedin the models: country (seven categories), gender (dichotomous), age (continuous), BMI (continuous),
smoking habits (five categories: non-smoker; ex-smoker; 1-10 units/day; 11-20 units/day; >20units/day), alcohol consumption (4 categories: teetotaller; 1 -7 units a week; 8-14 units/week; >14units/week), physical activity (2 categories: no or a little; regular), and education level (coded asquartiles of number of years in education previously standardized by country means).
2.5 Statistical analysis
Morning and evening cortisol levels were analysed separately.
As cortisol is a biological measure following a circadian rhythm, the relative variation in cortisol
per hour between both samplings was also investigated. The variation in cortisol per hour has been
divided by the morning level as reference level.
Each of these outcomes were firstly log-transformed to compensate for a non-normal distribution.
Then, each outcome was analysed in relation to aircraft noise exposure using linear regression,adjusted for the confounders.
Statistical analyses were carried out for men and women separately.

3. RESULTS
Means (sd) for cortisol outcomes were 24.1 (12.6), 5.5 (6.0), 0.08 (0.11) nmol.L-1 in men, and 23.9(13.4), 6.0 (6.5), 0.08 (0.07) nmol.L-1 in women, for the morning level, the evening level, and therelative variation respectively.
In women, significant associations were found between noise indicators (except LA eq, 24h where theassociation was border significant) and the evening cortisol level, suggesting an increase of cortisol
concentration with aircraft noise exposure level; and between every noise indicators and the relative
variation per hour, towards a flattening of the cortisol variation. Any association was found between
aircraft noise exposure and the morning cortisol level.
No association was found in men.
Table 1 – Linear regression results for the relation between aircraft noise exposure and cortisol outcomes
MALE
Morning level-1(nmol.L )Evening level

FEMALE
Relative variation-1(nmol.L )per hourMorning level-1(nmol.L )Evening level

Relative variation per-1(nmol.L )hour

exp(β)

CI95%exp(β)

CI95%exp(β)

CI95%exp(β)

CI95%exp(β)

CI95%exp(β)

CI95%LAeq,16h

0.99(0.92;1.06)

1.04(0.95;1.12)

0.97(0.90;1.04)

1.04(0.98;1.10)

1.08(1.00;1.16)

0.92(0.86;0.98)

LAeq,24h

0.98(0.91;1.05)

1.03(0.94;1.12)

0.96(0.89;1.04)

1.05(0.98;1.12)

1.08(1.00;1.17)

0.92(0.85;0.98)

Lden

0.99

(0.92;1.06)

1.04(0.95;1.14)

0.96(0.89;1.04)

1.03(0.97;1.10)

1.09(1.01;1.18)

0.90(0.84;0.97)

Lnight1.00(0.93;1.08)

1.05(0.97;1.15)

0.95(0.88;1.02)

1.00(0.94;1.07)

1.11(1.02;1.20)

0.89(0.83;0.96)

4. DISCUSSION
The results of the present study are partly in line with those found based on the DEBATS
participants only (8), where similar conclusions were drawn, but where no difference was shown
between gender subgroups. Considering the HYENA participants only, significant associations were
found only in women, but for an increase in the morning cortisol levels (9). The pooled-analyses,
providing a greater statistical power, found significant associations between aircraft noise exposureand modification of the cortisol stress-hormone secretion for women only.
The use of relative-variation per hour contributes to a new approach to analyze cortisol in relation

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to noise exposure. This allows for potential measurement differences between HYENA and DEBATS
related to sampling and cortisol determinations.
Associations were stronger for women with an exposure during the night. T he hypothesis thatwomen have a higher susceptibility to noise during sleep could be relevant (12). However, when sleep
duration was added to the model, results were similar.
Noise exposure was calculated at participants' home address. It does not take into account exposure
outside their home. However it is more likely that participants were in their home at night, so the L nightshould be the indicator closest to the real exposure: it may be the reason why the strongest associations
were observed for Lnight .

5. CONCLUSIONSThe present results support the hypothesis that exposure to aircraft noise could be related to higher
average values for the evening cortisol concentration, and therefore a flattening of the relative
variation between morning and evening levels, especially in women. However, the cause/effectrelations and the biological process between noise exposure and hormone dysregulation are still ofmajor importance and need to be elucidated.
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