Epidemiological Studies of the Cardiovascular effects of Occupational Noise - A Critical Appraisal.

Reviews of epidemiological studies of cardiovascular effects of occupational noise have been published regularly in the literature. The first part of this paper summarises the conclusions which have been drawn. The second part focuses in more detail on the results of studies in which noise exposure was not assessed by objective measurements, but on the basis of subjective ratings as given by the study subjects in a questionnaire. Finally, the paper addresses some issues of occupational noise studies which deserve special attention from the methodological and conceptual point of view. These are concerned with study design, statistical inference, selection and confounding bias, overcontrolling, effect modification and exposure misclassification.