Neurology. 2025 Jun 24;104(12):e213782. doi: 10.1212/WNL.0000000000213782. Epub 2025 May 30.
ABSTRACT
BACKGROUND AND OBJECTIVES: Stroke remains a major global public health concern, particularly in China, where particulate matter (PM2.5) pollution is a significant contributor to stroke mortality. This study systematically analyzes changes in stroke and subtype-specific mortality attributable to PM2.5 in China from 1990 to 2021 and projects trends up to 2030.
METHODS: Data were obtained from the Global Burden of Disease database. The mortality and standardized data of stroke and its subtypes attributable to PM2.5 in China were collected. Long-term trends were assessed using the joinpoint regression model. The age-period-cohort (a-p-c) model was applied to evaluate the effects of age, period, and birth cohort on stroke mortality. In addition, the Bayesian age-period-cohort model was used to forecast age-standardized mortality rate (ASMR) trends through 2030.
RESULTS: From 1990 to 2021, the ASMR of stroke attributable to PM2.5 in China showed a declining trend and was projected to decrease to 32.0 per 100,000 by 2030. However, significant differences were observed across stroke subtypes, age groups, and sexes. Subarachnoid hemorrhage (SAH) exhibited the largest decline while ischemic stroke (IS) had the smallest reduction. Local drift analysis showed that IS and intracerebral hemorrhage (ICH) declined fastest in those aged 45-60 years while SAH declined most in those aged 75-80 years. a-p-c model analysis demonstrated that stroke mortality increased with age, with IS mortality surpassing that of ICH in individuals aged 75 years and older and the gap widening with age. Stroke mortality risk declined over time, with younger cohorts showing greater reductions. The stroke burden remained higher in men than in women.
DISCUSSION: China has made significant progress in stroke prevention and air pollution control; however, disparities remain in the effectiveness of prevention across stroke subtypes and population groups. Further efforts should focus on strengthening pollution control, optimizing prevention strategies for each stroke subtype, enhancing hypertension management in middle-aged populations, improving metabolic risk control in older adults, and ensuring efficient health care resource allocation. Priority should be given to high-risk populations, particularly older individuals and men, to address the challenges posed by aging and the increasing burden of chronic diseases.
PMID:40446199 | DOI:10.1212/WNL.0000000000213782
