Enno Swart

Association between aircraft, road and railway traffic noise and depression in a large case-control study based on secondary data

Background Few studies have examined the relationship between traffic noise and depression providing inconclusive results. This large case‐control study is the first to assess and directly compare depression risks by aircraft, road traffic and railway noise. Methods The study population included individuals aged ≥40 years that were insured by three large statutory health insurance funds and were living in the region of Frankfurt international airport. Address‐specific exposure to aircraft, road and railway traffic noise in 2005 was estimated. Based on insurance claims and prescription data, 77,295 cases with a new clinical depression diagnosis between 2006 and 2010 were compared with 578,246 control subjects. Results For road traffic noise, a linear exposure‐risk relationship was found with an odds ratio (OR) of 1.17 (95% CI=1.10–1.25) for 24‐h continuous sound levels ≥70 dB. For aircraft noise, the risk estimates reached a maximum OR of 1.23 (95% CI=1.19–1.28) at 50–55 dB and decreased at higher exposure categories. For railway noise, risk estimates peaked at 60–65 dB (OR=1.15, 95% CI=1.08–1.22). The highest OR of 1.42 (95% CI=1.33–1.52) was found for a combined exposure to noise above 50 dB from all three sources. Conclusions This study indicates that traffic noise exposure might lead to depression. As a potential explanation for the decreasing risks at high traffic noise levels, vulnerable people might actively cope with noise (e.g. insulate or move away).

Breast cancer and exposure to aircraft, road, and railway-noise: a case–control study based on health insurance records

Objectives Aircraft, road, and rail traffic noise can cause sleep disturbances. Since night work and shorter sleep durations have been linked to increased risks of breast cancer, we examined if 24-hour, or day- or night-time traffic noise exposure may also increase the risk of breast cancer. Methods To investigate the noise-related risks of breast cancer, the pseudonymized insurance records of three large statutory health companies (2005-2010) for women aged ≥40 years living in the region surrounding the Frankfurt international airport were analyzed with address-specific acoustic data representing aircraft, road, and rail-traffic noise. Noise exposure among women with incident breast cancer (N=6643) were compared with that of control subjects (N=471xa0596) using logistic regression and adjusting for age, hormone replacement therapy, education and occupation (only available for 27.9%), and a regional proportion of persons receiving long-term unemployment benefits as an ecological indicator of socioeconomic level. Analyses were also stratified according to estrogen receptor (ER) status. Results An increased odds ratio (OR) was observed for ER negative (ER-) tumors at 24-hour aircraft noise levels 55-59 dB [OR 55-59 dB 1.41, 95% confidence interval (CI) 1.04-1.90] but not for ER positive (ER+) breast cancers (OR 55-59 dB 0.95, 95% CI 0.75-1.20). Clear associations between road and rail traffic noise were not observed. Conclusions The results indicate increased aircraft noise may be an etiologic factor for ER- breast cancers. However, information regarding potential confounding factors was largely unattainable. Further research is required to understand how environmental noise may be involved in the pathogenesis of ER- breast cancers.

Traffic noise and hypertension – results from a large case-control study

Background Environmental traffic noise is a potential cause of hypertension. We aimed to study the association between hypertension as recorded in health insurance claims data and the exposure to three sources of traffic noise (aircraft, road and rail). Methods This large case‐control study was conducted among persons aged 40 and above in 2010 and living in the region around Frankfurt airport in Germany. Individual residential noise exposure for the index year 2005 was assessed using standard noise algorithms. Cases were all newly diagnosed cases of hypertension recorded in three large health insurances databases in the period 2006–2010. Controls had no hypertension diagnosis. Categorical and continuous analyses were conducted with binary logistic regression models adjusted for sex, age and residential area‐based socioeconomic information. Results The main analysis included 137,577 cases and 355,591 controls. There were no associations with any of the traffic noise sources. Odds ratios (OR) per 10 dB noise increase were 0.99 (95% confidence interval: 0.98;1.01) for aircraft noise, and 1.00 (0.99;1.01) both for road and railway noise. Similarly, nighttime noise levels showed no associations with hypertension. Odds ratios were increased for the subgroup of newly diagnosed hypertension cases with a subsequent diagnosis of hypertensive heart disease: per 10 dB aircraft noise there was a 13.9% OR increase (6.0% for road traffic, 5.4% for rail traffic). Increases were also noted when we analyzed cases with a longer exposure‐outcome time window. Conclusion Our results are suggestive of an association of noise exposure with clinically more severe hypertension diagnoses, but not with uncomplicated hypertension. The absence of individual confounder data, however, adds to the risk of bias. The results contribute to evidence on traffic noise as a cardiovascular risk factor. HighlightsTraffic noise is a potentially important environmental cause of hypertension.This is the largest case‐control study of hypertension and traffic noise exposure so far.There was no association between uncomplicated hypertension and individual residential noise exposure.We found an association between hypertension followed by heart disease and exposure to aircraft‐, road‐ and railway noise.

Linking primary study data with administrative and claims data in a German cohort study on work, age, health and work participation: is there a consent bias?

OBJECTIVESnWe analysed the degree and impact of consent bias in the prospective study leben in der Arbeit (lidA) after linking primary interview data with claims data from German statutory health insurance funds as well as with administrative data provided by the German Federal Employment Agency.nnnSTUDY DESIGNnProspective cohort study.nnnMETHODSnWithin two study waves (2011, 2014) primary data were collected based on computer-assisted personal interviews. During interview informed consent to data linkage was obtained. We used binary logistic regression analyses with participants consent for record linkage as the dependent variable calculating odds ratios (ORs) and 95% confidence intervals (95% CIs) for independent variables. Several sociodemographic, socio-economic and work-related factors were modelled as potential determinants of consent.nnnRESULTSnA total of 4244 participants took part in both waves. After excluding invalid consent, 4178 participants were included in the analysis. About 3918 (93.8%) of these participants gave their consent to link their primary data with data from at least one source. Within regression analyses only moderate bias was found due to region of residence, apprenticeship, professional affiliations, income and number of diseases. Participants from former West Germany were less likely to have their study data linked with both data sources (OR 0.63 [95% CI 0.42-0.96]) than those from the former East Germany. Participants with no information on income were more likely to refuse consent to both data sources compared to the reference group (net income: under EUR 1000; OR 0.15 [95% CI 0.08-0.30]). Respondents with two (OR 1.37 [95% CI 1.06-1.77]) or three and more diseases (OR 1.30 [95% CI 1.02-1.66]) diagnosed by a doctor agreed more frequently to linking both data sources than participants without disease. There is just a small proportion of variance in consenting explained by the models (R2: 0.063-0.085). Also, only small changes of factors prevalence were observed in consenters.nnnCONCLUSIONSnFor the first time in Germany, the lidA-study links primary survey data with health claims and administrative employment data. We conclude that there is only a minor relation between the analysed factors and consent behaviour of the participants. A linked data set may be used in further analyses without substantial biases.

Claims Data for Evaluation

Integrated care aims at reorganizing and/or continuously enhancing care structures and processes to improve patient-related outcomes and economic results in standard every-day care. It also aims to boost patients’ and care providers’ satisfaction with and acceptance of medical care. The question is therefore to what extent we may use data generated in standard care when it comes to evaluating integrated care.

Linksherzkatheteruntersuchungen und ihre invasive Konsequenz – Regionalvergleiche ermitteln auffällige Unterschiede

BACKGROUND AND AIMSnDiagnostic left heart catheterization (LHC) is recommended if the therapeutic consequences of a bypass operation or percutaneous coronary intervention (PCI) are being considered. The present study examines regional differences in healthcare provision and therapeutic consequences of LHC, differentiated by counties and hospitals of the German federal state of Saxony-Anhalt. In addition, it looks at which patient-related factors influence the proportion of follow-up interventions. The relation between the rates of LHC, interventions and hospital discharge due to myocardial infarction is examined.nnnMETHODSnThe data of 9,791 individuals having statutory health insurance coverage by the AOK Saxony-Anhalt with 10,906 anonymized inpatient cases of LHCs in 2011 were followed until 12/31/2012, and it was examined whether they subsequently received a coronary bypass or PCI. The data was used to compare both the counties of Saxony-Anhalt (according to residence, adjusted for age and sex) and their hospitals. Regression analysis was run to identify determinants of receiving a LHC without consequences.nnnRESULTSnOverall, 54.2xa0% of the patients with LHC had no invasive follow-up intervention. Regression analysis showed an approximately linear relationship for the counties: the number of LHCs provided correlates with the number of LHCs requiring no PCI or bypass within a period of at least 12 months. Regional LHC rates are not correlated with hospitalizations due to acute myocardial infarction. No bypass or PCI in the follow-up period was reported for 37 to 85xa0% of the cases, depending on the hospital providing the LHC. Women and younger patients have a higher risk to undergo LHC without therapeutic impact.nnnDISCUSSIONnThe analysis indicates that there are specific regions in Saxony-Anhalt and diagnoses where the indications for LHC should be more conservative. However, more detailed analyses are needed to verify the identified potentials for improving healthcare provision.