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Length of occupational noise exposure and blood pressure*
Thierry Lang', Christiane Fouriaud2 , and Marie-Christine Jacquinet-Salord 2
1Groupe d'Epiddmiologie et de Recherche Clinique, Service d'Informatique Mddicale & INSERM U 194, CHU Pitid,
91 Bd de l'H 6pital, F-75013 Paris, France
2
APSAT, Association pour la sante de l'homme au travail
Received January 14 / Accepted August 16, 1991
Summary A cross-sectional study was performed in the
Paris area, with a total of 7901 subjects; 432 of them
were exposed to occupational noise 85 d BA Noise
was measured by the worksite physicians, and length of
exposure was collected through interview The subjects
exposed to noise were mainly workers, their body mass
index was higher and their job characteristics different
from the other subjects, assembly line, shift-work and
job under time pressure being more frequent Blood
pressure (BP) was higher among the exposed subjects;
this was no longer the case after adjustment for age,
body mass index and alcohol intake Taking length of ex-
posure into account, BP and the prevalence of hyperten-
sion increased for durations > 25 years This relationship
was still significant after adjustment for age, body mass
index and alcohol intake These results suggest that a
long occupational noise exposure is a risk factor for high
blood pressure.
Key words: Noise exposure Occupational medicine -
Arterial hypertension Epidemiology
Introduction
A positive relationship has been reported in several epi-
demiological studies between prolonged noise exposure
and blood pressure levels l5-9, 11, 14l However, due to
methodological problems, the role of chronic exposure
to noise as a risk factor for hypertension remains un-
clear In several studies, major risk factors of hyperten-
sion, such as overweight or alcohol consumption l10 l,
were not controlled for and could thus account for the
association observed l 5-9, 11, 14 l An effect of noise on
blood pressure was demonstrated in human beings by
experiments involving short periods of time only l1, 12 l.
The data of a cross-sectional study were therefore an-
alysed in order to investigate the relationship between
*This report was prepared on behalf of the APSAT group: G Bra-
dane, P Degoulet, D Deprouw, J Laprugne, I Mahe, P Manil-
lier, J Oeconomos, J Phalente, M J Ravelonanosy, I G Ravelo-
nanosy, F Rousseau and C Simonet.
Offprint requests to: T Lang.
S
International Archives of
OC Upalional
Environmental
Health
© Springer-Verlag 1992
prolonged exposure to noise and chronic elevation of
blood pressure, take into account the confounding fac-
tors which might explain the relationship observed and
describe the effect of the duration of exposure.
Subjects and methods
The population under study consisted of 7901 subjects working in
small and medium-sized companies of the Paris area (staff number
ranged from 1 to 998) These companies were mechanical or chem-
ical industries and in the tertiary sector, offices, garages, restaur-
ants The sole criterion for inclusion was being under the responsi-
bility of 1 of the 13 worksite physicians participating in the study.
In each company, an annual examination was mandatory; missing
subjects were requested to attend on a second day, so the partici-
pation rate was high, over 95 % Subjects who had been working in
the company for less than a year were not included Some physi-
cians decided to examine 1 subject out of 2, on a random basis; this
sample rate remained constant throughout the study.
Data were prospectively collected in 1986-1987, using a stan-
dard form concerning clinical examination, working conditions,
usual consumption of alcohol, coffee and tobacco and arterial
hypertension related information Several meetings were organized
before and throughout the study in order to avoid misinterpreta-
tion of the questionnaire by the physicians Blood pressure was
measured in a sitting position after 5 min rest with a mercury
sphygmomanometer and a cuff adapted to the size of the arm The
Korotkoff's phase V was used to measure the diastolic blood pres-
sure Hypertension was defined as systolic blood pressure (SBP)
160 and/or diastolic (DBP) 95mm Hg and/or current anti-
hypertensive treatment (WHO criteria).
Noise exposure measurement Noise exposure was defined as a
level 85 d BA, on the site of the job, for 8 h a day Temporary ex-
posures were not considered The noise level at the workplace was
measured at least twice by the medical staff in charge of the com-
pany, with a Bruel et Kjaer type 2219 sonometer On the exposed
job sites, levels ranging from 85 to 100 d BA were observed; levels
as high as 80 dBA were recorded in some places classified as quiet.
The total duration of the exposure was recorded as follows Previ-
ous exposures were estimated on the basis of the interview If the
description of the job was considered by the physicians to indicate
a noise exposure over 85 d BA, then the duration was added to the
years actually measured with the present job.
Statistical methods Several percentages were compared by the X2
test and means by Student's t-test and F-test Multi-variate analysis
was performed using a linear regression for continuous variables
and logistic regression for a qualitative variable The BMDP statis-
tical software programme was used l2l The odds ratio was calcu-
370

lated from the regression coefficient 3found in the logistic regres-
sion; binary variables were given the values 1 and -1 The odds
ratio was calculated as e 23.
Results
Population
Data were available for 7679 of the 7901 eligible subjects,
and 40% were women Mean age was 38 8 ± 11 2 years
(mean ± SD) and body mass index (BMI), 23 9 + 3 8 kg/
m2) According to occupational categories, managers ac-
counted for 3 2%, executives for 7 5 %, middle execu-
tives for 24%, employees for 22 8%, skilled workers for
18.4%, unskilled workers for 13 8 % and service person-
nel for 5% of the subjects Mean size of the companies
was 114 6 + 183 2 salaried subjects (range 1-998) Some
709 men and 363 women were found to be hypertensive;
the prevalence of hypertension was thus 14%.
Characteristicsof the population exposed
to occupational noise
A total of 432 subjects were exposed to a noise level over
85 dBA Among them, 43 9 % reported a length of expo-
sure from 1 to 9 years, 19 8 % from 10 to 14 years, 13 9 %
from 15 to 19 years, 11 1% from 20 to 24 years and 11 4 %
25 years and more.
As compared with the unexposed population, the
percentage of men was higher among the subjects ex-
posed ( 83% versus 59 %, P < 0 001) The mean age was
not different In contrast, BMI was higher in the group
exposed (24 3 + 4 0 vs 23 9 4 0 kg/m2 , P < 0 05), as
were alcohol consumption (27 5 + 38 6 vs 16 8 ± 28 6 g/
day, P < 0 001); tobacco consumption ( 9 3 + 11 6 vs.
7.0 + 10 7 cigarettes/day, P < 0 001) and coffee consump-
tion ( 2 8 + 2 1 vs 2 5 ± 2 2 cups/day, P < 0 001) Skilled
and unskilled workers were more frequently exposed
( 11 0% and 14 0%, respectively) than the remaining
categories ( 1 7%) (P < 0 001) The size of the company
was larger for exposed subjects ( 160 6 ± 214 5 employees
vs 114 1 + 182 5, P< O 001) The following job charac-
teristics were associated with an occupational noise ex-
posure: assembly line, shift-work and job under time
pressure: 42 4% of the assembly line workers were ex-
posed as opposed to 4 3% of the other workers (P<
0.001); among the 232 shift-workers, 32 6 % were exposed
versus 4 3% for the other workers (P < 0 001); noise was
associated with work under time pressure in 10 3 % of
1870 subjects, as compared with 3 8% of the other 5789
subjects.
Currentnoise exposure and blood pressure

Table 1 Current occupational noise exposure and blood pressure Systolic BP was higher among exposed subjects than un-
exposed subjects (Table 1) The same tendency was ob-
Current noise exposure P served for diastolic BP After adjusting for age, BMI, al-
' 85dBA <8 dBA cohol consumption and occupational category, in a linear
(n = 432) (n = 7247) regression this relation was no longer significant.
Systolic blood pressure 132 4 (15 6) 128 8 ( 16 4) < 0 001
(mm Hg) Arterialhypertension, blood pressure levels
Diastolic blood pressure 80 8 (11 1) 79 3 (11 8) < 0 05 and length of exposure
(mm Hg)
Since occupational category, related to both BP and noise
Mean (standard deviation) exposure, is a major potential confounding factor in the

Table 2 Length of occupational noise expo-

Length of exposure 0 1-9 10-19 20-24 25 + P
sure, blood pressure (BP) and risk factors
(years)
for arterial hypertension among 1986 male
workers n 1717 113 98 21 37
Age (years) 38 3 31 0 42 0 48 1 45 7 < 0 001
(10 8) (8 5) (9 2) (7 3) (12 2)
Alcohol (g/day) 28 0 25 5 38 6 25 7 27 2 NS
( 36 5) (34 0) (53 8) (28 2) (33 5)
Body mass index 24 2 23 3 24 9 25 2 24 3 < 0 05
(kg/m 2 ) (3 7) (3 8) (3 7) (4 4) (3 6)
Systolic BP 132 3 130 7 130 7 135 7 140 2 < 0 001
(mm Hg) ( 16 0) (13 2) (13 7) (20 9) (23 7)
Diastolic BP 80 7 79 4 79 6 82 6 86 7 < 0 001
(mm Hg) ( 11 9) (10 8) (10 4) (10 0) (14 6)
Arterial 14 4 71 82 19 0 37 8 < O 001 a
hypertension (%)
Mean (standard deviation)
a Duration of exposure 20-24 years and 25 years were combined for the X2 test

Table 3 Relationship of blood pressure
(BP) and occupational noise exposure for 25
years and larger among 1844 male workers
untreated for hypertension (multiple linear
regression analysis) Age (years)
Body mass index (kg/m 2)
Alcohol consumption (g/day)
Noise exposure (-25 years = 1)
Constant
study of this relationship, the analysis was conducted in
the group of workers who are homogeneous in this re-
spect and accounted for 80 % of the exposed population.
Few women had been exposed for long periods of time;
female workers were thus excluded from further calcula-
tions Obviously, age and length of exposure were asso-
ciated Systolic and diastolic BP were higher for dura-
tions of 20 years and more Similarly, the prevalence of
hypertension increased from 8 2 % for exposures lasting
10-19 years to 19%, from 20 to 24 years and 37 8%, over
24 years (P < 0 001) (Table 2) In order to take into ac-
count the effects of age and the main risk factors for high
BP, a linear regression was computed Age, BMI and al-
cohol intake were positively associated with BP levels
(P < 0 001 each) If the threshold used to define a long
exposure was 20 years, a positive association was observed
with systolic (P = 0 05) and diastolic BP (P < 0 05) An
exposure over 25 years or more was associated with sys-
tolic and diastolic BP (Table 3) Adjusted systolic BP
was 10 3 mmHg higher and diastolic BP 8 3mm Hg higher
than those of workers exposed for shorter periods of time
or unexposed subjects Excluding the 54 subjects taking
antihypertensive medication, the results were very close
as far as statistical significance and BP changes were con-
cerned.
The prevalence of hypertension (WHO criteria: BP Ž
160/95 mm Hg and/or current antihypertensive treatment)
was used as a dependent variable in a logistic regression.
A long ( 25 years) occupational exposure was associ-
ated with the prevalence of hypertension (P<0 06).
From the coefficient of this analysis, the odds ratio was
found to be 2 59 ( 95 % confidence interval 0 96-6 99).
Discussion
In a population of workers, an occupational exposure
over 25 years and more was found to be a risk factor for
hypertension, after adjustment for the main lifestyle
characteristics associated with high BP The population
under study was not a random sample of French work-
ers; however, the sole criterion for inclusion was to be
working in a company for which one of the participating
worksite was responsible A high response rate, since
the examination is mandatory, makes a selection bias
unlikely to explain the results The "healthy worker ef-
fect" and the exclusion from noisy jobs of subjects suffer-
ing from diseases related to noise would tend to decrease
an association between a disease and its risk factor In
contrast, random errors in classification and measure-
371
Systolic BP Diastolic BP
Coefficient (SD) P Coefficient(SD) P
0 277 (0 033) < 0 001 0 186 (0 025) < 0 001
0 634 (0 096) < 0 001 0 542 (0 070) < 0 001
0 043 (0 009) < O 001 0 041 (0 007) < O 001
10 658 (3 798) < 0 01 7 839 (2 842) < 0 01
104 505 58 81
ment should be discussed when considering the results of
this study This is true for BP, which was measured in a
single visit This is especially true for the noise exposure.
Although it was measured by the worksite medical service,
it is difficult to assess with accuracy the precise levels to
which a worker is exposed during 8 h a day all year long.
The retrospective analysis of previous exposures tends to
minimize reported exposures since the experts and the
subjects recorded types of work which were undoubtedly
noisy Lastly, non-occupational exposures were not con-
sidered in this study although they have been shown to
be risk factors for high BP l8 l All these methodological
problems tend to decrease the calculated correlation be-
tween two variables which are truly associated rather
than produce a false one As a result, this type of error
would tend to underestimate the relationship between
noise and BP.
This relation was observed after adjustment for sev-
eral confounding factors which had not been considered
in previous studies reporting an association between BP
and noise Still, it is clear from our investigation that
subjects working under noisy conditions are very differ-
ent from the general population with respect to several
lifestyle and job characteristics, such as BMI, alcohol in-
take, occupational categories and working conditions.
They often work in assembly line or shiftwork and under
time pressure, which results in additional stress These
peculiarities should be considered in any study of the re-
lationship between noise and cardiovascular diseases.
Our results suggest that the minimum duration of ex-
posure necessary to observe a relationship with BP is at
least 20 years and more clearly, 25 years This is concor-
dant with the reports of Parvizpoor among weavers, show-
ing an increase in the prevalence of hypertension after 20
years l 11l Similarly, Verbeek observed an increase in
BP levels after 20 years of exposure l 14l In contrast,
some studies l5, 6 l including a previous work of our
group l4 l reported a higher BP among currently exposed
groups and unexposed subjects, irrespective of the dura-
tion of exposure This might not be contradictory if the
exposed groups were composed of a large group of work-
ers exposed for a long time to loud noises This is so for
instance, in a report involving seamen among which the
mean duration of exposure was 25 years l6 l This long
duration of exposure required to induce chronic eleva-
tion of BP might explain the contradictory results ob-
served when hearing loss is taken as an indicator of pro-
longed noise exposure l9,13l Cohen (in l13 l) suggests
that the minimum length of exposure could be longer for
BP chronic elevation than for induction of hearing loss.
372
Our study, being cross-sectional, cannot prove the
causality of the relationship This latter is suggested by
the concordance of the studies among various popula-
tions Cavatorta et al reported a higher prevalence of
hypertension among 60 workers exposed to 90 dBA and
more; in an experimental study, they were able to show
higher levels of circulating catecholamines and higher
urinary excretion during working hours, as compared
with 60 controls l3 l A possible biological pathway is
thus possible; however, these results are to be consid-
ered as demonstrating acute effects of noise only.
In conclusion, our results suggest that a long expo-
sure to noise over 85 dBA might be a risk factor for high
BP, contributing to an increase in BP in the population
and possibly inducing major increases of BP among sen-
sitive individuals.
Acknowledgements This work was supported by a grant (no 87283)
from the French Secretariat d'Etat charge de l'Environment, de la
prevention des risques technologiques et naturels majeurs.
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