Residential road traffic noise as a risk factor for hypertension in adults: Systematic review and meta-analysis of analytic studies published in the period 2011-2017.

Multiple cross-sectional studies indicated an association between hypertension and road traffic noise and they were recently synthetized in a WHO systematic evidence review. However, recent years have seen a growing body of high-quality, large-scale research, which is missing from the WHO review. Therefore, we aimed to close that gap by conducting an updated systematic review and meta-analysis on the exposure-response relationship between residential road traffic noise and the risk of hypertension in adults. Studies were identified by searching MEDLINE, EMBASE, the Internet, conference proceedings, reference lists, and expert archives in English, Russian, and Spanish through August 5, 2017. The risk of bias for each extracted estimate and the overall quality of evidence were evaluated using a list of predefined safeguards against bias related to different study characteristics and the Grading of Recommendations Assessment, Development and Evaluation system, respectively. The inverse variance heterogeneity (IVhet) model was used for meta-analysis. The possibility of publication bias was evaluated by funnel and Doi plots, and asymmetry in these was tested with Egger's test and the Luis Furuya-Kanamori index, respectively. Sensitivity analyses included leave-one-out meta-analysis, subgroup meta-analysis with meta-regressions, and non-linear exposure-response meta-analysis. Based on seven cohort and two case-control studies (n = 5 514 555; 14 estimates; Lden range ≈ 25-90 dB(A)), we found "low" evidence of RR per 10 dB(A) = 1.018 (95% CI: 0.984, 1.053), moderate heterogeneity (I2 = 46%), and no publication bias. In the subgroup of cohort studies, we found "moderate" evidence of RR per 10 dB(A) = 1.018 (95% CI: 0.987, 1.049), I2 = 31%, and no publication bias. In conclusion, residential road traffic noise was associated with higher risk of hypertension in adults, but the risk was lower than previously reported in the systematic review literature.