{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T21:42:46Z","timestamp":1788817366824,"version":"build-2803163510"},"reference-count":43,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001921","name":"Public Health Research programme","doi-asserted-by":"publisher","award":["15\/192\/13"],"award-info":[{"award-number":["15\/192\/13"]}],"id":[{"id":"10.13039\/501100001921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":[],"abstract":"Background<\/jats:title>\nLong-term exposure to aircraft noise has been associated with small increases in cardiovascular disease risk, but there are almost no short-term exposure studies.<\/jats:p>\n<\/jats:sec>\nObjectives<\/jats:title>\nResearch questions were:<\/jats:p>\n\nIs there an association between short-term changes in exposure to aircraft noise and cardiovascular morbidity and mortality?<\/jats:p><\/jats:list-item>\nWhat are the key effect modifiers?<\/jats:p><\/jats:list-item>\nIs there variability in risk estimates between areas with consistent versus changing patterns of noise exposure?<\/jats:p><\/jats:list-item>\nDo risk estimates differ when using different noise metrics?<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:sec>\nDesign<\/jats:title>\nDescriptive analyses of noise levels and variability at different times of day, analyses of inequalities in noise exposure and case-crossover analyses of cardiovascular events in relation to aircraft noise exposure.<\/jats:p>\n<\/jats:sec>\nSetting<\/jats:title>\nArea surrounding London Heathrow airport.<\/jats:p>\n<\/jats:sec>\nTime period<\/jats:title>\n2014\u201318.<\/jats:p>\n<\/jats:sec>\nParticipants<\/jats:title>\nWhole population in study area.<\/jats:p>\n<\/jats:sec>\nMain outcome measures<\/jats:title>\nCardiovascular disease hospitalisations and mortality.<\/jats:p>\n<\/jats:sec>\nData sources<\/jats:title>\n\nAircraft noise levels modelled using a standard noise model for: (1) daily equivalent continuous sound levels at different times of day; (2) daily number of events above defined noise thresholds (2018 only).<\/jats:p><\/jats:list-item>\nNational Health Service digital hospital admission records and Office for National Statistics mortality records for 2014\u201318 for cardiovascular outcomes, plus individual-level confounders available from healthcare records.<\/jats:p><\/jats:list-item>\nConfounder data including road traffic noise (Leicester modelled), rail noise and air pollution (Department for Environment, Food and Rural Affairs), area level deprivation and ethnicity (UK Census).<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:sec>\nResults<\/jats:title>\nThe morning shoulder period (06.00\u201307.00 hours) was the noisiest of all eight bands (mean: 50.92 dB). The morning shoulder period also had the third highest number of noisy events (flights)\u2005>\u200560 dB per day, with three events across postcodes on average. However, the highest number of noisy events occurred in daytime (highest between 07.00 and 15.00 hours, second highest 15.00 and 19.00 hours).<\/jats:p>\nTo identify areas with high variability in aircraft noise exposure (due to changes in flight paths because of wind direction and airport operations), we used coefficients of variation (CoV). The period 24.00\u201304.30 hours had the highest mean CoV (67.33\u201374.16), followed by 04.30\u201306.00 hours and 23.00\u201324.00 hours.<\/jats:p>\nPostcodes in the least deprived quintiles of Carstairs index or avoidable death rate had the lowest noise levels.<\/jats:p>\nIn case-crossover analyses, we observed increased risk for cardiovascular disease hospital admissions for evening noise 19.00\u201323.00 hours (odds ratio 1.005, 95% confidence interval 1.000 to 1.010 per 5 dB), but not for other periods or mortality. Further analyses suggested that increased risks were occurring in postcodes with low CoV for noise. We found effect modification by age, sex, ethnicity, deprivation and season.<\/jats:p>\n<\/jats:sec>\nLimitations<\/jats:title>\nThe industry standard noise model, the Aviation Environmental Design Tool, used does not take account of wind direction, which may have led to some exposure misclassification.<\/jats:p>\n<\/jats:sec>\nConclusions<\/jats:title>\nWe developed a comprehensive dataset of daily aircraft noise variability.<\/jats:p>\nWe found small associations between cardiovascular hospitalisations (but not deaths) and evening aircraft noise levels, particularly in areas with low variability of noise.<\/jats:p>\n<\/jats:sec>\nFuture work<\/jats:title>\nMore studies are needed to understand the effect of noise variation and respite\/relief on cardiovascular disease.<\/jats:p>\n<\/jats:sec>\nFunding<\/jats:title>\nThis award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15\/192\/13) and is published in full in Public Health Research<\/jats:italic>; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/utce9104","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T06:58:53Z","timestamp":1733727533000},"page":"1-58","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of short-term aircraft noise on cardiovascular disease risk in the area surrounding London Heathrow airport: the RISTANCO epidemiological study"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8985-9756","authenticated-orcid":true,"given":"Xiangpu","family":"Gong","sequence":"first","affiliation":[{"name":"Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5076-3522","authenticated-orcid":true,"given":"Nicole","family":"Itzkowitz","sequence":"additional","affiliation":[{"name":"Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0464-8448","authenticated-orcid":true,"given":"Calvin","family":"Jephcote","sequence":"additional","affiliation":[{"name":"Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-709X","authenticated-orcid":true,"given":"Kathryn","family":"Adams","sequence":"additional","affiliation":[{"name":"Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4678-2015","authenticated-orcid":true,"given":"Glory O","family":"Atilola","sequence":"additional","affiliation":[{"name":"Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3423-2013","authenticated-orcid":true,"given":"John","family":"Gulliver","sequence":"additional","affiliation":[{"name":"Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-704X","authenticated-orcid":true,"given":"Marta","family":"Blangiardo","sequence":"additional","affiliation":[{"name":"Medical Research Council Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9904-7447","authenticated-orcid":true,"given":"Anna","family":"Hansell","sequence":"additional","affiliation":[{"name":"Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2024,12]]},"reference":[{"key":"key2024120912200700_ref2-bib2","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1097\/HJH.0b013e328352ac54","article-title":"The quantitative relationship between road traffic noise and hypertension: a meta-analysis","volume":"30","author":"van Kempen","year":"2012","journal-title":"J Hypertens"},{"key":"key2024120912200700_ref3-bib3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.4103\/1463-1741.53363","article-title":"Exposure-response relationship of the association between aircraft noise and the risk of hypertension","volume":"11","author":"Babisch","year":"2009","journal-title":"Noise Health"},{"key":"key2024120912200700_ref4-bib4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4103\/1463-1741.153400","article-title":"Is there an association between aircraft noise exposure and the incidence of hypertension? 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Annual Fuel Poverty Statistics Report: 2022 (2020 data). London; 2022. URL: www.gov.uk\/government\/collections\/fuel-poverty-statistics (accessed 23 November 2022)."},{"key":"key2024120912200700_ref36-bib36","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1002\/hec.1461","article-title":"Measuring health inequality with realization of potential life years (RePLY)","volume":"18","author":"Tang","year":"2009","journal-title":"Health Econ"},{"key":"key2024120912200700_ref38-bib38","volume-title":"Avoidable Mortality in Great Britain Statistical Bulletins","author":"Office for National Statistics","year":"2021"},{"key":"key2024120912200700_ref40-bib40","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/oxfordjournals.aje.a115853","article-title":"The case-crossover design: a method for studying transient effects on the risk of acute events","volume":"133","author":"Maclure","year":"1991","journal-title":"Am J Epidemiol"},{"key":"key2024120912200700_ref41-bib41","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1093\/oxfordjournals.aje.a117550","article-title":"Control sampling strategies for case-crossover studies: an assessment of relative efficiency","volume":"142","author":"Mittleman","year":"1995","journal-title":"Am J Epidemiol"},{"key":"key2024120912200700_ref42-bib42","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/eurheartj\/ehaa957","article-title":"Does night-time aircraft noise trigger mortality? 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