Background

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates.

Objectives

We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (<85 dBA), on the prevalence, incidence and mortality of ischaemic heart disease (IHD), stroke, and hypertension.

Data sources

A protocol was developed and published, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies up to 1 April 2019, including International Trials Register, Ovid MEDLINE, PubMed, Embase, Lilacs, Scopus, Web of Science, and CISDOC. The MEDLINE and Pubmed searches were updated on 31 January 2020. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts.

Study eligibility and criteria

We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of any occupational exposure to noise on CVD prevalence, incidence or mortality, compared with the theoretical minimum risk exposure level (<85 dBA).

Study appraisal and synthesis methods

At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We prioritized evidence from cohort studies and combined relative risk estimates using random-effect meta-analysis. To assess the robustness of findings, we conducted sensitivity analyses (leave-one-out meta-analysis and used as alternative fixed effects and inverse-variance heterogeneity estimators). At least two review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide tools and approaches adapted to this project.

Results

Seventeen studies (11 cohort studies, six case-control studies) met the inclusion criteria, comprising a total of 534,688 participants (39,947 or 7.47% females) in 11 countries in three WHO regions (the Americas, Europe, and the Western Pacific). The exposure was generally assessed with dosimetry, sound level meter and/or official or company records. The outcome was most commonly assessed using health records. We are very uncertain (low quality of evidence) about the effect of occupational exposure to noise (≥85 dBA), compared with no occupational exposure to noise (<85 dBA), on: having IHD (0 studies); acquiring IHD (relative risk (RR) 1.29, 95% confidence interval (95% CI) 1.15 to 1.43, two studies, 11,758 participants, I² 0%); dying from IHD (RR 1.03, 95% CI 0.93–1.14, four studies, 198,926 participants, I² 26%); having stroke (0 studies); acquiring stroke (RR 1.11, 95% CI 0.82–1.65, two studies, 170,000 participants, I² 0%); dying from stroke (RR 1.02, 95% CI 0.93–1.12, three studies, 195,539 participants, I² 0%); having hypertension (0 studies); acquiring hypertension (RR 1.07, 95% CI 0.90–1.28, three studies, four estimates, 147,820 participants, I² 52%); and dying from hypertension (0 studies). Data for subgroup analyses were missing. Sensitivity analyses supported the main analyses.

Conclusions

For acquiring IHD, we judged the existing body of evidence from human data to provide “limited evidence of harmfulness”; a positive relationship is observed between exposure and outcome where chance, bias, and confounding cannot be ruled out with reasonable confidence. For all other included outcomes, the bodies of evidence were judged as “inadequate evidence of harmfulness”. Producing estimates for the burden of CVD attributable to occupational exposure to noise appears to not be evidence-based at this time.

Protocol identifier

10.1016/j.envint.2018.09.040.

PROSPERO registration number

CRD42018092272.

中文翻译：

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职业性噪声暴露对缺血性心脏病、中风和高血压的影响：世界卫生组织/国际劳工组织对与工作相关的疾病和伤害负担的联合估计的系统回顾和荟萃分析

背景

世界卫生组织 (WHO) 和国际劳工组织 (ILO) 正在开发与工作相关的疾病和伤害负担的联合估算（WHO/ILO 联合估算），并得到大量个人专家的贡献。来自机械数据的证据表明，职业性噪声暴露可能导致心血管疾病 (CVD)。在本文中，我们对用于估计因职业暴露于噪声而导致的 CVD 死亡人数和残疾调整生命年数的参数进行了系统回顾和荟萃分析，以制定 WHO/ILO 联合估计。

目标

我们旨在系统地审查和荟萃分析任何（高）职业噪声暴露（≥85 dBA）与没有（低）职业噪声暴露（<85 dBA）对流行率、发生率和缺血性心脏病（IHD）、中风和高血压的死亡率。

数据源

制定并发布了一项协议，在可行的情况下将导航指南用作组织系统审查框架。我们在电子学术数据库中搜索了截至 2019 年 4 月 1 日已发表和未发表的研究的潜在相关记录，包括 International Trials Register、Ovid MEDLINE、PubMed、Embase、Lilacs、Scopus、Web of Science 和 CISDOC。MEDLINE 和 Pubmed 搜索于 2020 年 1 月 31 日更新。我们还搜索了灰色文献数据库、互联网搜索引擎和组织网站；手动搜索以前系统评价的参考列表和包括的研究记录；并咨询了其他专家。

研究资格和标准

我们包括任何 WHO 和/或 ILO 成员国的正规和非正规经济中的工作年龄（≥15 岁）工人，但不包括儿童（<15 岁）和无薪家庭工人。我们纳入了随机对照试验、队列研究、病例对照研究和其他非随机干预研究，与理论最低风险暴露水平（< 85 分贝）。

研究评价与综合方法

至少有两名综述作者在第一阶段根据资格标准独立筛选标题和摘要，在第二阶段独立筛选可能符合条件的记录的全文，然后从符合条件的研究中提取数据。我们优先考虑来自队列研究的证据，并使用随机效应荟萃分析结合相对风险估计。为了评估结果的稳健性，我们进行了敏感性分析（留一法荟萃分析并用作替代固定效应和反方差异质性估计量）。至少有两名综述作者使用适用于该项目的导航指南工具和方法评估了偏倚风险、证据质量和证据强度。

结果

17 项研究（11 项队列研究，6 项病例对照研究）符合纳入标准，包括来自三个 WHO 区域（美洲、欧洲和西太平洋）的 11 个国家的 534,688 名参与者（39,947 名或 7.47% 的女性）。暴露通常通过剂量测定、声级计和/或官方或公司记录进行评估。最常使用健康记录评估结果。我们非常不确定（证据质量低）职业性噪声暴露（≥85 dBA）与没有职业性噪声暴露（<85 dBA）相比，对：患有IHD（0项研究）；获得 IHD（相对风险 (RR) 1.29，95% 置信区间 (95% CI) 1.15 至 1.43，两项研究，11,758 名参与者，I ² 0%）；死于 IHD（RR 1.03，95% CI 0.93–1.14，四项研究，198,926 名参与者，I² 26%）；中风（0 项研究）；中风（RR 1.11，95% CI 0.82–1.65，两项研究，170,000 名参与者，I ² 0%）；死于中风（RR 1.02，95% CI 0.93–1.12，三项研究，195,539 名参与者，I ² 0%）；患有高血压（0 项研究）；患高血压（RR 1.07，95% CI 0.90–1.28，三项研究，四项估计，147,820 名参与者，I ² 52%）；死于高血压（0 项研究）。亚组分析的数据缺失。敏感性分析支持主要分析。

结论

为了获得 IHD，我们从人类数据中判断现有的证据提供了“有限的有害证据”；在不能以合理的信心排除机会、偏见和混杂因素的情况下，暴露与结果之间存在正相关关系。对于所有其他纳入的结果，证据主体被判断为“不充分的有害证据”。目前，对职业性噪声暴露导致的 CVD 负担进行估计似乎没有证据基础。

协议标识符

10.1016/j.envint.2018.09.040。

PROSPERO 注册号

CRD42018092272。