Different change patterns and sex difference for stroke and its subtypes mortality attributable to tobacco in China...

Tobacco use is one of the major risk factors of stroke. However, the dynamic changes in stroke attributable to tobacco over the past three decades in China remain unclear, as does the potential differential effect of tobacco on different stroke subtypes.

Data was derived from the Global Burden of Disease 2021 study. Tobacco use was defined as current or past usage of any smoked tobacco product and the average daily exposure to air particulate matter from second-hand smoking. Joinpoint regression and age-period-cohort analysis were adopted to analyze the trends in stroke mortality due to tobacco.

From 1990 to 2021, the age-standardized mortality rates (ASMR) for stroke attributable to tobacco exhibited a declining trend. Ischemic stroke (IS) exhibited the smallest decline, while subarachnoid hemorrhage (SAH) showed the largest decline. The curve of the net drifts showed a downward trend for all stroke subtypes irrespective of sex. Among stroke subtypes, mortality reductions were most pronounced in SAH, followed by intracerebral hemorrhage (ICH), and IS. The mortality of IS and ICH increased rapidly with age, while the mortality rate for SAH showed fluctuations with age. Both period and cohort rate ratios for stroke mortality attributable to tobacco have declined, with the most significant reduction observed in SAH and the least in IS. Stroke mortality attributable to tobacco in men was chiefly associated with active smoking, whereas in women, second-hand smoking was the predominant factor, exhibiting a gradual upward trend.

In the past three decades, the risk ratio and ASMR of stroke attributable to tobacco showed the declining trend, and different stroke subtypes exhibited different change patterns in China. There was a gender disparity in the effects of active smoking and second-hand smoke exposure on men and women. Policies aimed at preventing tobacco-related stroke in the future must take the varying effects across different stroke subtypes and genders into account.