Occupational Noise Exposure and the Risk for Work-Related Injury: A Systematic Review and Meta-analysis

Objectives: Occupational noise exposure has been linked to work-related injuries. Strategies to control occupational hazards often rely on dose-response relationships needed to inform policy, but quantitative synthesis of the relevant literature has not been done so far. This study aimed to systematically review the epidemiological literature and to perform meta-analysis of the risk for work-related injury due to occupational noise exposure. Methods: PRISMA and MOOSE guidelines were followed. PubMed, ScienceDirect, and Google Scholar were searched up until 15 December 2016 in English, Russian, and Spanish. Reference lists, grey literature, and expert archives were searched as well. The risk of bias was assessed for each study and incorporated into the meta-analysis weights using the quality effects model. Results: Overall, 21 studies were included at the qualitative review stage: 9 cross-sectional, 6 case-control, 4 cohort, 1 case-crossover, and 1 ecological. Noise exposure was assessed objectively in 13 studies. Information on occupational injuries was elicited from medical records/registry in 13 studies. Meta-analyses showed RR = 1.22 (95% CI: 1.15, 1.29) (n = 59 028) per 5 dB increase in noise exposure (Cochran's Q = 27.26, P < 0.001, I-2 = 67%) and RR = 2.16 (95% CI: 1.61, 2.90) (n = 96 023) in the most exposed group (> 90-95 dB) compared with the least exposed group (Cochran's Q = 180.46, P < 0.001, I-2 = 90%). Subgroup analysis with meta-regression revealed an overall robust pooled risk per 5 dB. Conclusions: There is a dose-response association between occupational noise exposure and work-related injury risk. However, the quality of evidence is 'very low'; therefore, the magnitude of this association should be interpreted with caution.