Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2026, Vol. 40 ›› Issue (3): 47-54.doi: 10.6040/j.issn.1673-3770.0.2025.393

• Original Article • Previous Articles     Next Articles

Association and lag effects of environmental meteorological factors on epistaxis in minors by sex

LIU Di1, XIE Yingheng1,2, ZHU Bin1, MA Lin1,3, GUAN Bing1, WANG Ying1, CAO Qing1, JIAO Cheng1, YAN Qi1, SUN Haiyong1, MA Wei1,2,3   

  1. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Northern Jiangsu People's Hospital, Yangzhou 225001, Jiangsu, China2. Department of Otorhinolaryngology, Head and Neck Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, Jiangsu, China3. Department of Otorhinolaryngology, Head and Neck Surgery, Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou 225001, Jiangsu, China
  • Published:2026-05-22

Abstract: Objective To investigate the sex-specific associations and lag effects between environmental meteorological factors and epistaxis incidence in minors, providing evidence for targeted prevention strategies. Methods A retrospective analysis was conducted on minors with epistaxis who visited the outpatient and emergency departments of Northern Jiangsu People's Hospital from January 1, 2015 to December 31, 2023. Data on daily air pollutant concentrations and meteorological variables during the same period were collected. The Mann-Whitney U test was used to compare incidence-related indicators between sexes. Spearman's rank correlation and a lag model(L0-L7)were employed to evaluate the correlations and lag effects between daily epistaxis cases and environmental meteorological factors stratified by sex, with significance levels adjusted using the Bonferroni method. Fisher's Z transformation was applied to compare correlation coefficients between male and female groups. Results A total of 18,280 patients were included, comprising 12,000 males(65.65%)and 6,280 females(34.35%). The incidence was significantly higher in males than in females(P<0.001), with both sexes showing a peak in summer. Daily epistaxis cases were strongly positively correlated with O3 mass concentration and mean temperature, with lag effects persisting to L7; the differences in correlation coefficients between sexes were statistically significant(P<0.05). Sex differences were observed in the lag effects of PM2.5, PM10, and CO, with males exhibiting higher correlation coefficients for most pollutants. Temperature difference was positively correlated with case numbers, peaking at L2, and was higher in females on the day of onset(P<0.05). After Bonferroni correction, NO2 and SO2 showed no significant correlations(P>0.05), and the effect of wind speed was limited. Conclusion Epistaxis in minors exhibits significant sex differences and a summer peak. The associations and lag effects between epistaxis and environmental meteorological factors are sex-specific, which should be considered when formulating prevention strategies.

Key words: Minors, Epistaxis, Sex, Environmental meteorological factors, Lag effect

CLC Number: 

  • R765.23
[1] Send T, Bertlich M, Eichhorn KW, et al. Etiology, management, and outcome of pediatric epistaxis[J]. Pediatr Emerg Care, 2021, 37(9): 466-470. doi:10.1097/pec.0000000000001698
[2] Kubba H. Childhood epistaxis[J]. Clin Otolaryngol, 2006, 31(3): 212-213. doi:10.1111/j.1749-4486.2006.01238.x
[3] Mohideen RSPM, Thangaraj M. Relationship between temporal pattern perception test and mismatch negativity in children with auditory processing disorder and dyslexia[J]. J Audiol Otol, 2023, 27(1): 16-23. doi:10.7874/jao.2022.00297
[4] Kwak IY, Kim KS, Min HJ. Differential effect of meteorological factors and particulate matter with ≤10-μm diameter on epistaxis in younger and older children[J]. Sci Rep, 2022, 12(1): 21029. doi: 10.1038/s41598-022-25630-3. doi:10.1038/s41598-022-25630-3
[5] 谷庆隆, 高兴强, 罗征秀, 等. 儿童鼻出血诊断与治疗: 临床实践指南(2021年)[J]. 中国实用儿科杂志, 2021, 36(10): 721-724. doi:10.19538/j.ek2021100601 GU Qinglong, Gao Xingqiang, LUO Zhengxiu, et al. Diagnosis and treatment of epistaxis in children-clinical practice guidelines(2021)[J]. Chinese Journal of Practical Pediatrics, 2021, 36(10): 721-724. doi:10.16066/j.1672-7002.2021.06.01
[6] 王梅, 王新兰, 徐百成, 等. 儿童急性扁桃体炎与环境气象因素的相关性研究[J]. 中国耳鼻咽喉头颈外科, 2021, 28(6): 383-386, 390. doi:10.16066/j.1672-7002.2021.06.01 WANG Mei, WANG Xinlan, XU Baicheng, et al. Study on the correlation between acute tonsillitis in children and environmental meteorological factors[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(6): 383-386, 390. doi:10.16066/j.1672-7002.2021.06.01
[7] Yu G, Fu Y, Dong C, et al. Is the occurrence of pediatric epistaxis related to climatic variables?[J]. Int J Pediatr Otorhinolaryngol, 2018, 113: 182-187. doi: 10.1016/j.ijporl
[8] Yuan WM, Lu YQ, Wei Z, et al. An epistaxis emergency associated with multiple pollutants in elementary students[J]. Biomed Environ Sci, 2016, 29(12): 893-897. doi:10.3967/bes2016.119
[9] Purkey MR, Seeskin Z, Chandra R. Seasonal variation and predictors of epistaxis[J]. Laryngoscope, 2014, 124(9): 2028-2033. doi:10.1002/lary.24679
[10] Mangussi-Gomes J, Enout MJR, de Castro TC, et al. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study[J]. Acta Otolaryngol, 2016, 136(11): 1184-1189. doi:10.1080/00016489.2016.1191673
[11] Sowerby LJ, DeSerres JJ, Rudmik L, et al. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada[J]. J Otolaryngol Head Neck Surg, 2014, 43(1): 10. doi: 10.1186/1916-0216-43-10
[12] Bray D, Giddings CEB, Monnery P, et al. Epistaxis: are temperature and seasonal variations true factors in incidence?[J]. J Laryngol Otol, 2005, 119(9): 724-726. doi:10.1258/0022215054798032
[13] Lu YX, Liang JQ, Gu QL, et al. Pediatric epistaxis and its correlation between air pollutants in Beijing from 2014 to 2017[J]. Ear Nose Throat J, 2020, 99(8): 513-517. doi:10.1177/0145561319852581
[14] Szyszkowicz M, Shutt R, Kousha T, et al. Air pollution and emergency department visits for epistaxis[J]. Clin Otolaryngol, 2014, 39(6): 345-351. doi:10.1111/coa.12296
[15] Min SJ, Kang H, Kim KS, et al. Minimal temperature, mean wind speed, and mean relative humidity are associated with spontaneous epistaxis in Seoul, Korea[J]. Auris Nasus Larynx, 2021, 48(1): 98-103. doi:10.1016/j.anl.2020.07.012
[16] Ahn EJ, Min HJ. Age-specific associations between environmental factors and epistaxis[J]. Front Public Health, 2022, 10: 966461. doi: 10.3389/fpubh.2022.966461
[17] Ahn EJ, Min HJ. Environmental factors differentially affect epistaxis among preschool and school-aged children[J]. Front Public Health, 2023, 11: 1178531. doi: 10.3389/fpubh.2023.1178531
[18] Matsumoto S, Ishii R, Kiuchi C, et al. Effect of average relative humidity on epistaxis[J]. Cureus, 2023, 15(3): e36063. doi: 10.7759/cureus.36063
[19] Fishpool SJC, Tomkinson A. Patterns of hospital admission with epistaxis for 26, 725 patients over an 18-year period in Wales, UK[J]. Ann R Coll Surg Engl, 2012, 94(8): 559-562. doi:10.1308/003588412x13373405386691
[20] Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department[J]. Int J Pediatr Otorhinolaryngol, 2017, 103: 121-124. doi: 10.1016/j.ijporl.2017.10.026
[21] Sharifi A, Hwang PH, Zojaji M, et al. Environmental factors and the incidence of pediatric epistaxis: a systematic review with meta-analysis[J]. Int J Pediatr Otorhinolaryngol, 2024, 186: 112152. doi: 10.1016/j.ijporl.2024.112152
[22] Hachicha A, Chouchane H, Boussafa H, et al. Epistaxis in children with allergic rhinitis: clinical features and risk factors depending on the allergen profile[J]. Tunis Med, 2024, 102(11): 927-932. doi:10.62438/tunismed.v102i11.5129
[23] Seidel DU, Sesterhenn AM, Kostev K. Seasonal variation of epistaxis in Germany[J]. J Craniofac Surg, 2018, 29(4): e365-e367. doi:10.1097/scs.0000000000004351
[24] Wei EX, Green A, Chang MT, et al. Environmental risk factors for pediatric epistaxis vary by climate zone[J]. Laryngoscope, 2024, 134(3): 1450-1456. doi:10.1002/lary.30961
[25] Calderón-Garcidueñas L, Rodríguez-Alcaraz A, Villarreal-Calderón A, et al. Nasal epithelium as a sentinel for airborne environmental pollution[J]. Toxicol Sci, 1998, 46(2): 352-364. doi:10.1006/toxs.1998.2549
[26] 孙娜, 黄昱, 章如新, 等. 臭氧对变应性鼻炎鼻黏膜NF-κB p65核蛋白表达及炎性因子的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 237-244, 253. doi: 10.6040/j.issn.1673-3770.0.2021.564 SUN Na, HUANG Yu, ZHANG Ruxin, et al. Effects of ozone on nuclear protein expression of NF-κB p65 in nasal mucosa and inflammatory factors in a rat model of allergic rhinitis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(3): 237-244, 253. doi: 10.6040/j.issn.1673-3770.0.2021.564
[27] Kim K, Kwak IY, Min H. Particulate matter 10(PM10)is associated with epistaxis in children and adults[J]. Int J Environ Res Public Health, 2021, 18(9): 4809. doi: 10.3390/ijerph18094809
[28] Akdo gan MV, Hızal E, Semiz M, et al. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis[J]. Ear Nose Throat J, 2018, 97(9): E1-E5. doi:10.1177/014556131809700901
[29] 张淼, 杨颖超, 付指辉, 等. 自主神经功能紊乱与鼻科疾病关系研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 142-148. doi: 10.6040/j.issn.1673-3770.0.2022.215 ZHANG Miao, YANG Yingchao, FU Zhihui, et al. Research progress in the relationship between autonomic nervous system dysfunction and nasal diseases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(5): 142-148. doi: 10.6040/j.issn.1673-3770.0.2022.215
[30] Giddens WE Jr, Fairchild GA. Effects of sulfur dioxide on the nasal mucosa of mice[J]. Arch Environ Health, 1972, 25(3): 166-173. doi:10.1080/00039896.1972.10666156
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