Particulate Matter 10 (PM10) Is Associated with Epistaxis in Children and Adults

Relationship Between Environmental Meteorological Factors and the Incidence of Epistaxis in Different Age Groups in Yangzhou

Objective: To investigate the relationship between environmental and meteorological factors and the incidence of epistaxis in different age groups in Yangzhou, as well as to provide a reference and theoretical basis for epistaxis prevention and treatment. Methods: The patients with epistaxis who were treated in Northern Jiangsu People's Hospital of Jiangsu Province from January 2016 to December 2020 were reviewed, and the relationship between the local environmental meteorological factors at the time of onset and the incidence of epistaxis in different age groups was analyzed, and the potential environmental meteorological risk factors of epistaxis in each age group were determined by Stepwise logistic regression. Results: From 2016 to 2020, there were 24,407 cases of epistaxis, mostly males and children. The effects of O3 concentration, average humidity, average temperature, NO2 concentration, sunshine duration, average wind speed, CO concentration, and temperature difference on the study population were statistically significant (P < .05). Analysis by age group showed that there were differences in environmental and meteorological factors related to epistaxis in different age groups. Conclusions: In Yangzhou, epistaxis is more prevalent among males and children. The environmental meteorological factors are related to the incidence of epistaxis in Yangzhou, among which the average humidity and temperature difference are negatively correlated with the incidence of epistaxis. In contrast O3 concentration, average temperature, NO2 concentration, sunshine duration, average wind speed, and CO concentration are positively correlated with epistaxis occurrence. However, the impact of these environmental and meteorological factors varies in different age groups.

Air pollution and serious bleeding events in high-risk older adults

IMPORTANCE

Despite biological plausibility, very few epidemiologic studies have investigated the risks of clinically significant bleeding events due to particulate air pollution.

OBJECTIVE

To measure the independent and synergistic effects of PM2.5 exposure and anticoagulant use on serious bleeding events.

DESIGN

Retrospective cohort study (2008-2016).

SETTING

Nationwide Medicare population.

PARTICIPANTS

A 50% random sample of Medicare Part D-eligible Fee-for-Service beneficiaries at high risk for cardiovascular and thromboembolic events.

EXPOSURES

Fine particulate matter (PM2.5) and anticoagulant drugs (apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin).

MAIN OUTCOMES AND MEASURES

The outcomes were acute hospitalizations for gastrointestinal bleeding, intracranial bleeding, or epistaxis. Hazard ratios and 95% CIs for PM2.5 exposure were estimated by fitting inverse probability weighted marginal structural Cox proportional hazards models. The relative excess risk due to interaction was used to assess additive-scale interaction between PM2.5 exposure and anticoagulant use.

RESULTS

The study cohort included 1.86 million high-risk older adults (mean age 77, 60% male, 87% White, 8% Black, 30% anticoagulant users, mean PM2.5 exposure 8.81 μg/m3). A 10 μg/m3 increase in PM2.5 was associated with a 48% (95% CI: 45%-52%), 58% (95% CI: 49%-68%) and 55% (95% CI: 37%-76%) increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis, respectively. Significant additive interaction between PM2.5 exposure and anticoagulant use was observed for gastrointestinal and intracranial bleeding.

CONCLUSIONS

Among older adults at high risk for cardiovascular and thromboembolic events, increasing PM2.5 exposure was significantly associated with increased risk of gastrointestinal bleeding, intracranial bleeding, and epistaxis. In addition, PM2.5 exposure and anticoagulant use may act together to increase risks of severe gastrointestinal and intracranial bleeding. Thus, clinicians may recommend that high-risk individuals limit their outdoor air pollution exposure during periods of increased PM2.5 concentrations. Our findings may inform environmental policies to protect the health of vulnerable populations.

Relationship Between Air Pollutants and the Incidence of Epistaxis in Yangzhou

Objectives: This project aims to explore the relationship between the air quality index (AQI), the concentration of 6 air pollutants, and the incidence of epistaxis in Yangzhou. Also, to provide reference information for the prevention and treatment of epistaxis. Methods: Data of patients with epistaxis admitted to the Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2017 to December 2021 were collected. In addition, the local AQI and the concentrations of 6 air pollutants, namely particulate matter (PM2.5, PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3), were analyzed at the time of onset. Furthermore, the correlation with the incidence of epistaxis has been analyzed. Results: From 2017 to 2021, there were 24,721 patients with epistaxis aged from 0 to 17 years old while male patients were more than females. The incidence was higher in April, May, and June. There was a statistically significant difference in the number of daily epistaxis in different months and under AQI conditions (P < .05). Spearman's correlation analysis showed that there was a positive correlation between the number of daily epistaxis and the concentrations of AQI, CO, NO2, O3, PM2.5, PM10, and SO2 in Yangzhou, in which O3, PM10, and SO2 were highly correlated with the average number of daily epistaxis, and there was no obvious time lag effect of air pollutants on epistaxis. Conclusion: Epistaxis in the Yangzhou area is more common in males, mostly occurs in 0 to 17 years old, with seasonal. There was also a positive correlation between the incidence of epistaxis and air pollutants in Yangzhou. Therefore, by reducing the AQI index in daily life, and reducing the concentration of environmental pollutants in the air, the occurrence of epistaxis could be prevented and reduced to a certain extent.

Environmental factors differentially affect epistaxis among preschool and school-aged children

Introduction

Environmental factors are closely associated with pediatric epistaxis. Whether this association differs according to age has not been previously reported. Therefore, we tried to evaluate the differences in associations between environmental factors and epistaxis in children of different ages.

Methods

A total of 20,234 patients with epistaxis who visited the hospital between January 1, 2002, and December 31, 2015, were enrolled in this study. The patients were divided into two groups according to their ages: preschool-aged (<6 years) and school-aged children (6-18 years). Daily, monthly, and yearly data on environmental factors were collected. We performed a stepwise logistic regression to identify the potential environmental risk factors for epistaxis in each age group.

Results

The mean number of epistaxis cases per month in both groups was highest in September. The cases were lowest in February in preschool-aged children and in November in school-aged children. Temperature, humidity, maximum wind speed, and sunshine duration were associated with epistaxis in preschool-aged children. Average wind speed, particulate matter (>10 μm diameter), temperature, humidity, sunshine duration, and sulfur dioxide concentration were associated with epistaxis in school-aged children.

Conclusion

This study indicates that the differences in environmental risk factors for epistaxis are associated with the patient's age.

Latinx and Indigenous Mexican Caregivers' Perspectives of the Salton Sea Environment on Children's Asthma, Respiratory Health, and Co-Presenting Health Conditions

This research investigated Latinx and Indigenous Mexican caregivers' perspectives of the Salton Sea's environment (e.g., dust concentrations and other toxins) on child health conditions. The Salton Sea is a highly saline drying lakebed located in the Inland Southern California desert borderland region and is surrounded by agricultural fields. Children of Latinx and Indigenous Mexican immigrant families are especially vulnerable to the Salton Sea's environmental impact on chronic health conditions due to their proximity to the Salton Sea and structural vulnerability. From September 2020 to February 2021, we conducted semi-structured interviews and focus groups with a total of 36 Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress living along the Salton Sea. A community investigator trained in qualitative research conducted interviews in Spanish or Purépecha, an indigenous language spoken by immigrants from Michoacán, Mexico. Template and matrix analysis was used to identify themes and patterns across interviews and focus groups. Participants characterized the Salton Sea's environment as toxic, marked by exposure to sulfuric smells, dust storms, chemicals, and fires, all of which contribute to children's chronic health conditions (e.g., respiratory illnesses such as asthma, bronchitis, and pneumonia, co-presenting with allergies and nosebleeds). The findings have important environmental public health significance for structurally vulnerable child populations in the United States and globally.

Differential effect of meteorological factors and particulate matter with ≤ 10-µm diameter on epistaxis in younger and older children

The differential effect of meteorological factors and air pollutants on pediatric epistaxis in younger and older children has not been evaluated. We evaluated the distribution of pediatric epistaxis cases between younger (0-5 years) and older children (6-18 years). Subsequently, we assessed and compared the effects of meteorological variables and the concentration of particulate matter measuring ≤ 10 μm in diameter (PM10) on hospital epistaxis presentation in younger and older children. This retrospective study included pediatric patients (n = 326) who presented with spontaneous epistaxis between January 2015 and August 2019. Meteorological conditions and PM10 concentration were the exposure variables, and data were obtained from Korea Meteorological Administration 75. The presence and cumulative number of epistaxis presentations per day were considered outcome variables. Air temperature, wind speed, sunshine duration, and PM10 concentration in younger children, and sunshine duration and air pressure in older children, significantly correlated with the presence of and cumulative number of epistaxis presentations per day. The PM10 concentration was not a significant factor in older children. Thus, meteorological factors and PM10 concentration may differentially affect epistaxis in younger (0-5-year-olds) and older (6-18-year-olds) children. Risk factors for pediatric epistaxis should be considered according to age.

Age-specific associations between environmental factors and epistaxis

Objective

Several 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 design

A retrospective cohort study.

Setting

Records 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.

Methods

The 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.

Results

Age 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.

Conclusion

We suggest that the environmental risk factors for epistaxis should be differentially analyzed according to age.