Age-specific associations between environmental factors and epistaxis

Abstract

ObjectiveSeveral studies have demonstrated that environmental factors, such as meteorological factors and air pollutants, are closely associated with epistaxis. However, age-specific associations between environmental factors and epistaxis have not yet been evaluated. This study aimed to evaluate the associations between individual meteorological factors and air pollutants and epistaxis, by age.Study designA retrospective cohort study.SettingRecords of patients covered by the Korean National Health Insurance Service who visited our hospital for epistaxis between January 1, 2002, and December 31, 2015, were retrospectively reviewed.MethodsThe 46,628 enrolled patients were divided into four age groups: age group 0 (<18 years, N = 19,580); age group 1 (18–40 years, N = 10,978); age group 2 (41–70 years, N = 13,395); and age group 3 (>70 years, N = 2,675). Cases of epistaxis and data on environmental factors were analyzed according to the day, month, and year. Stepwise logistic regression was performed to identify the environmental risk factors for epistaxis in each age group.ResultsAge group 0 had the highest number of patients with epistaxis, whereas age group 3 had the lowest. Relative humidity, temperature, concentrations of particulate matter (PM10) and sulfur dioxide, sunshine duration, and wind speed were significantly associated with the occurrence of epistaxis in the study population. However, analysis according to age group showed that the meteorological factors and air pollutants associated with epistaxis were different in each age group.ConclusionWe suggest that the environmental risk factors for epistaxis should be differentially analyzed according to age.

Environmental Risk Factors for Pediatric Epistaxis vary by Climate Zone

“…Traditionally, the incidence of spontaneous epistaxis has been thought to be negatively correlated with ambient temperature, which has been demonstrated and repeated in many settings including the United Kingdom (U.K.), Korea, and Italy. 2,[4][5][6][7] One recent study examining internet search engine queries in major cities in the U.S. found that epistaxis search activity was inversely correlated with temperature, with this trend being strongest in cities with the greatest seasonal variations in temperature such as New York, Philadelphia, and Atlanta. 8 Interestingly, even amongst studies that have demonstrated a negative relationship between temperature and incidence of epistaxis, there have been substantial variations in the effect size of this correlation.…”

“…Similar to prior studies, we found inverse associations between humidity and epistaxis incidence. 2,5,7,23 Under the IECC climate zone classification system, moist and dry humidity subclassifications were given for temperature zones 1-6. We found statistically significant increases in epistaxis rates in dry climate zones compared to moist climate zones for temperature zones 3-6, but interestingly not for temperature zones 1-2.…”

“…Additionally, we found significant seasonal variations in epistaxis rate and specifically decreased rates of epistaxis in summer and fall months compared to winter and spring months also consistent with prior literature. 2,4,5 The reasons for higher epistaxis rates during winter relative to summer is likely multifactorial and at least partially attributable to temperature variations as discussed above. In winter months, the increased utilization of indoor heating has also been shown to lead to lower intranasal humidity which may cause desiccation and fragility of nasal mucosa, thereby increasing the risk of bleeding.…”

“…1 With increasing awareness of climate change and its impact on severe weather fluctuations and human health, a growing body of literature has emerged exploring relationships between meteorological factors such as temperature, humidity, and seasonality with incidence of common medical conditions such as epistaxis. [2][3][4][5][6][7][8][9][10][11] However, the results of these studies have remained seemingly inconsistent at times. For example, although a majority have reported increased epistaxis incidence with colder temperatures, 2,[4][5][6][7] other studies have found no relationship between epistaxis incidence and temperature or conversely increased epistaxis incidence with higher temperatures.…”

“…[2][3][4][5][6][7][8][9][10][11] However, the results of these studies have remained seemingly inconsistent at times. For example, although a majority have reported increased epistaxis incidence with colder temperatures, 2,[4][5][6][7] other studies have found no relationship between epistaxis incidence and temperature or conversely increased epistaxis incidence with higher temperatures. 3,9,12,13 Notably, there remains an absence of population-wide studies examining how associations between meteorological factors and incidence of pediatric epistaxis might vary in different climate zones that might help to synthesize these disparate findings.…”