Patterns of hospital attendance with epistaxis

The age and sex distribution of epistaxis admissions to hospital was examined. A retrospective analysis of 6,885 patients admitted to hospitals in the whole of Wales was performed, over a period of five years. The findings were compared with data from the 1991 National Population Census for the same region, thus providing a more representative estimate of the behaviour of this disease. A clear age relationship is demonstrated, with the incidence of epistaxis increasing rapidly after the age of 40 years. The female-to-male ratio is also age dependent. In the group aged between 20 to 49 years twice as many males as females were admitted, where no sex difference was expected from the population data. This difference was not present in the group aged 50 years and over where the ratio was similar to that in the underlying population. There was a 1.6 fold difference between the sex ratios of the two groups (95% confidence intervals of 1.9 to 1.4; p < 0.0001). It is possible that the female pre-menopausal state may provide a significant protection from this disease. The mechanism for this is unknown, but may be secondary to a direct effect of oestrogen on the nasal mucosa or vasculature, or the healing of vessels in this region. Alternatively, this observation may simply be a reflection of protection the pre-menopausal state provides against cardiovascular disease in general.