Auditory and non-auditory effects of noise on health: updated evidence and future directions.

Noise is a ubiquitous environmental pollutant, prevalent in many residential, occupational, and recreational settings, posing an unmet challenge and injustice that can cause auditory and non-auditory health effects. In Europe alone, 112 million people - more than 20% of the population - are exposed to noise levels that exceed thresholds considered unhealthy. Auditory effects of exposure, including declines in hearing function and associated underlying noise-induced injury, have been extensively documented. Affecting many millions worldwide, auditory consequences of noise exposure interfere with communication, isolating individuals from family, friends, and co-workers, and exacerbate functional declines with age. Due to an increasing number of mechanistic and epidemiological cohort studies, the past twenty years have seen a shift from skepticism that noise could affect non-auditory health, to increasing evidence for effects on cardiometabolic disease, annoyance, sleep disturbance, mental health, dementia, and children's learning. Evidence for mechanisms via cortical activation and stress hormones leading to increased vascular and cerebral inflammation and oxidative stress has increased. Efforts to protect public health are expected to intensify over the next 10 years, as evidence informs guidance and policy aimed at protecting and promoting public health.