INTRODUCTION AND OBJECTIVES: Odour annoyance forms the main source of environmental stress in residents living in the proximity of animal feeding operations (AFOs) and it has been associated with reduced health. This study aims to gain more insight into the association between AFOs in the neighbourhood, odour annoyance, other environmental stressors, and health, and incorporates health care seeking behaviour for reported symptoms. MATERIALS AND METHODS: Cross-sectional data from 753 people living in an area in the Netherlands with a high density of AFOs was evaluated. Odour and other environmental annoyances in the neighbourhood, general health and symptom reporting were obtained by questionnaire. Health care utilisation was obtained from electronic medical records of general practices. The number of pigs, poultry and cattle within a 500 m radius from homes was computed using Geographic Information System data. Mutually adjusted multiple Poisson and (ordinal) logistic regression analyses were performed. RESULTS: The number of pigs, poultry and cattle was equally associated with odour annoyance. This annoyance was associated with reduced general health and increased reporting of respiratory, gastrointestinal, neurological and stress-related symptoms. Participants rarely consulted their general practitioner for reported symptoms. Environmental stressors were weakly associated. CONCLUSIONS: The number of animals around the homes was associated with odour annoyance. Odour annoyance was associated with reduced health, which could be a reason for caution with the construction of new AFOs.