Szyszkowicz, M.,* Shutt, R.,* Kousha, T.* & Rowe, B.H.† *Population Studies Division, Health Canada, Ottawa, ON, †Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB, Canada Accepted for publication 3 August 2014 Clin. Otolaryngol. 2014, 39, 345–351
Objectives: This study aimed to evaluate the association between outdoor ambient air pollution and emergency department (ED) visits for epistaxis. Design: Cross-sectional study, case–crossover design. Setting: ED visit data were obtained for Edmonton, Alberta, Canada, for a period of 10 years starting 1 April 1992 and ending March 31st of 2002. The data on ED visits were supplied by Capital Health for the five major acute care hospitals in the Edmonton area. Participants: The analysis was performed for the population as a whole (N = 15 038) and split by sex: males (N = 8587) and females (N = 6451). Main outcome measures: We explored associations between ambient concentrations of air pollutants (CO, NO2,
SO2, O3, PM10, PM2.5) lagged by 0–4 days and ED visits for epistaxis in Edmonton, Alberta, Canada. Results: Odds ratios (ORs) and their 95% confidence intervals (CI) were reported for an increase in an interquartile range (IQR) of pollutant concentration. We obtained positive and statistically significant results for all patients with epistaxis; exposure to O3 with IQR = 14 ppb, OR = 1.05 (95% CI: 1.00–1.09, lag 0), and for males (age < 25 years), OR = 1.16 (1.03–1.30), lag 4; and to PM10 with IQR = 15 lg/m3, OR = 1.02 (1.00– 1.05, lag 3). These results were stronger for older (age > 24 years) females. Conclusions: These findings suggest that there may be an association between air pollutant exposure, specifically ozone and PM10, and the number of ED visits for epistaxis.
This study examines potential correlations between ambient air pollution exposure and emergency department (ED) visits for epistaxis. Epistaxis (clinical term for nosebleed) is a frequent cause of ED presentations, otolaryngology referral and admission to hospital.1,2 According to The International Classification of Diseases, 9th Revision (ICD-9) epistaxis is classified by its corresponding code 784.7. Epistaxis, especially posterior epistaxis, can be a life threatening source of severe haemorrhage.1 Causes of epistaxis include bleeding disorders, use of non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulant therapies, intranasal neoplasm, trauma (internal or external) and conditions which dry the nasal mucosa, such as low humidity and ageing.1,2 Many studies have used ED visit and otolaryngology admission databases to examine factors which may influence rates of epistaxis presentation in EDs or the course of epistaxis treatment.2–6 Medication use and age have both been shown to modify rates of epistaxis in epidemiological studies.2,4,5 Temperature and humidity levels have long been linked to rates of epistaxis. Several groups have investigated the
potential link between meteorological conditions and epistaxis.6–10 Air pollution is a complex mixture which has been shown to have significant health effects. Air pollution mixtures and single components of air pollution have been shown to adversely affect the cardiovascular system, including effects on blood pressure,11 heart rate variability,12 as well as risk of stroke.13 The incidence of positive chest X-ray for small airway disease is greater in otherwise healthy children living in areas of high pollution.14 Furthermore, a study of male volunteers from areas of higher pollutant exposure has increased incidence of lesions in the nasal mucosa, along with other pathologies.15 Air pollution could play a role in the incidence of non-traumatic epistaxis. In a review of medical records from St George’s Hospital, London, UK (1997–2002), 1373 identified cases of epistaxis were linked with air pollution data to show positive correlations between hospital epistaxis presentation and increasing concentrations of PM10 and ozone.16 The aim of the current study therefore was to investigate correlations between ambient air pollution exposure and ED visits for epistaxis within the Canadian context through use of data collected in Edmonton, Alberta.
Correspondence: Dr. M. Szyszkowicz, Health Canada, 200 Eglantine Driveway, Ottawa, ON, K1A 0K9, Canada. Tel.: (613) 948-4629; Fax: (613) 954-3768; e-mail: [email protected]
© 2014 Her Majesty the Queen in Right of Canada Clinical Otolaryngology © 2014 John Wiley & Sons Ltd Reproduced with the permission of the Minister of Health 39, 345–351
345
ORIGINAL ARTICLE
Air pollution and emergency department visits for epistaxis
346 M. Szyszkowicz et al.
Methods Study setting
ED visit data were obtained for Edmonton, Alberta, Canada, for a period of 10 years starting 1 April 1992 and ending March 31st of 2002. ED visit data were supplied by Capital Health (now called Alberta Health Services (AHS) – Edmonton Zone) for five major acute care hospitals. Environmental conditions
The environmental data were obtained from Environment Canada (see NAPS Web site: http://www.ec.gc.ca/rnspanaps/NapsData). Carbon monoxide (CO), nitrogen dioxide (NO2), ground-level ozone (O3) and particulate matter (diameter
Objectives: This study aimed to evaluate the association between outdoor ambient air pollution and emergency department (ED) visits for epistaxis. Design: Cross-sectional study, case–crossover design. Setting: ED visit data were obtained for Edmonton, Alberta, Canada, for a period of 10 years starting 1 April 1992 and ending March 31st of 2002. The data on ED visits were supplied by Capital Health for the five major acute care hospitals in the Edmonton area. Participants: The analysis was performed for the population as a whole (N = 15 038) and split by sex: males (N = 8587) and females (N = 6451). Main outcome measures: We explored associations between ambient concentrations of air pollutants (CO, NO2,
SO2, O3, PM10, PM2.5) lagged by 0–4 days and ED visits for epistaxis in Edmonton, Alberta, Canada. Results: Odds ratios (ORs) and their 95% confidence intervals (CI) were reported for an increase in an interquartile range (IQR) of pollutant concentration. We obtained positive and statistically significant results for all patients with epistaxis; exposure to O3 with IQR = 14 ppb, OR = 1.05 (95% CI: 1.00–1.09, lag 0), and for males (age < 25 years), OR = 1.16 (1.03–1.30), lag 4; and to PM10 with IQR = 15 lg/m3, OR = 1.02 (1.00– 1.05, lag 3). These results were stronger for older (age > 24 years) females. Conclusions: These findings suggest that there may be an association between air pollutant exposure, specifically ozone and PM10, and the number of ED visits for epistaxis.
This study examines potential correlations between ambient air pollution exposure and emergency department (ED) visits for epistaxis. Epistaxis (clinical term for nosebleed) is a frequent cause of ED presentations, otolaryngology referral and admission to hospital.1,2 According to The International Classification of Diseases, 9th Revision (ICD-9) epistaxis is classified by its corresponding code 784.7. Epistaxis, especially posterior epistaxis, can be a life threatening source of severe haemorrhage.1 Causes of epistaxis include bleeding disorders, use of non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulant therapies, intranasal neoplasm, trauma (internal or external) and conditions which dry the nasal mucosa, such as low humidity and ageing.1,2 Many studies have used ED visit and otolaryngology admission databases to examine factors which may influence rates of epistaxis presentation in EDs or the course of epistaxis treatment.2–6 Medication use and age have both been shown to modify rates of epistaxis in epidemiological studies.2,4,5 Temperature and humidity levels have long been linked to rates of epistaxis. Several groups have investigated the
potential link between meteorological conditions and epistaxis.6–10 Air pollution is a complex mixture which has been shown to have significant health effects. Air pollution mixtures and single components of air pollution have been shown to adversely affect the cardiovascular system, including effects on blood pressure,11 heart rate variability,12 as well as risk of stroke.13 The incidence of positive chest X-ray for small airway disease is greater in otherwise healthy children living in areas of high pollution.14 Furthermore, a study of male volunteers from areas of higher pollutant exposure has increased incidence of lesions in the nasal mucosa, along with other pathologies.15 Air pollution could play a role in the incidence of non-traumatic epistaxis. In a review of medical records from St George’s Hospital, London, UK (1997–2002), 1373 identified cases of epistaxis were linked with air pollution data to show positive correlations between hospital epistaxis presentation and increasing concentrations of PM10 and ozone.16 The aim of the current study therefore was to investigate correlations between ambient air pollution exposure and ED visits for epistaxis within the Canadian context through use of data collected in Edmonton, Alberta.
Correspondence: Dr. M. Szyszkowicz, Health Canada, 200 Eglantine Driveway, Ottawa, ON, K1A 0K9, Canada. Tel.: (613) 948-4629; Fax: (613) 954-3768; e-mail: [email protected]
© 2014 Her Majesty the Queen in Right of Canada Clinical Otolaryngology © 2014 John Wiley & Sons Ltd Reproduced with the permission of the Minister of Health 39, 345–351
345
ORIGINAL ARTICLE
Air pollution and emergency department visits for epistaxis
346 M. Szyszkowicz et al.
Methods Study setting
ED visit data were obtained for Edmonton, Alberta, Canada, for a period of 10 years starting 1 April 1992 and ending March 31st of 2002. ED visit data were supplied by Capital Health (now called Alberta Health Services (AHS) – Edmonton Zone) for five major acute care hospitals. Environmental conditions
The environmental data were obtained from Environment Canada (see NAPS Web site: http://www.ec.gc.ca/rnspanaps/NapsData). Carbon monoxide (CO), nitrogen dioxide (NO2), ground-level ozone (O3) and particulate matter (diameter
