Stroke burden analysis attributable to ambient and household PM_2.5 in China from 1990 to 2021 based on GBD 2021

Driven by rapid urbanization and economic growth, PM_2.5 pollution has emerged as a pressing issue exacerbating the stroke burden, especially in developing nations such as China. As a preventable and measurable risk factor, the stroke burden attributable to ambient and household PM_2.5 has not yet received adequate attention. The data were collected from Global Burden of Disease (GBD) database from 1990-2021.The disease burdens (death, DALYs, YLLs and YLDs) of three subtypes of stroke, including intracerebral hemorrhage (ICH), ischemic stroke (IS) and subarachnoid hemorrhage (SAH), attributable to ambient and household PM2.5 by gender and age groups were explored. Jointpoint regression was employed to calculate annual average percentage changes (AAPCs). And the disease burden was predicted by Bayesian age-period-cohort (BAPC) model. The death, DALY, and YLL number of ICH and IS attributable to both ambient and household PM_2.5 were the main components of the total stroke burden globally and in China, with ICH being higher than IS. From 1990 to 2021, the overall number of stroke burdens was increased with increasing ambient PM_2.5 exposure. The AAPC changes of ASDR, ASR and YLL standardized rates for ICH and IS in China peaked at ages of 55-59. The ASDRs of ICH and IS attributable to ambient PM_2.5 were slowly increased in the next 25 years, approximately final doubling from 2021. The stable and increasing burden of stroke suggests that effective measures of ambient and household PM_2.5 should be continuously strengthened by the Chinese and global governments jointly for specific populations, especially middle-aged and elderly people in China.