Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Department of Neurosurgery, Qingyang People's Hospital, Qingyang, 745000, China.
BMC Public Health. 2024 Oct 11;24(1):2786. doi: 10.1186/s12889-024-20230-4.
Exposure to air pollution contributes to cardiovascular disease-related deaths and morbidity, including stroke. However, few studies have examined the global stroke burden linked to air pollution. This study aimed to evaluate the global stroke morbidity and mortality associated with air pollution from 1990 to 2021.
With the Global Burden of Disease Study (GBD) 2021, the numbers, and age-standardized rates (ASRs) of deaths and disability-adjusted life years (DALYs) for air pollution-related stroke were reported globally. Further subgroup analyses were conducted by age, sex, region and country, and stroke subtypes. A linear regression model explored global temporal trends and a cluster analysis examined temporal trends across GBD regions. To predict trends until 2040, the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model were applied.
In 2021, there were 1,989,686 (95% uncertainty interval [95% UI], 1,530,479-2,493,238) deaths and 44,962,167 (95% UI, 35,020,339 - 55,467,024) DALYs due to air pollution-related stroke. The ASRs increased with age, peaking generally over 85 years. Males, the Central African region, and Guinea-Bissau showed higher stroke burdens Intracerebral hemorrhage was the most lethal subtype, with an ASR of 11.69 (95% UI 8.94-14.69) for deaths and 276.93 (95% UI 212.21-344.36) for DALYs. From 1990 to 2021, the crude number of deaths and DALYs increased by 13.4% and 6.3%, respectively, for the global stroke burden but showed a declining trend when age-standardized. Most GBD regions in Asia and Africa experienced an increasing stroke burden linked to air pollution, while Europe and America showed a decreasing trend. Predictions indicated a gradual reduction in ASRs, with higher rates in males from 2020 to 2040.
The global stroke burden associated with air pollution remained significant despite a decreasing trend until 2021. Although future predictions suggested a reduction, the crude counts for stroke burden remained substantial, with significant regional disparities. This warranted the implementation of public health policies and ongoing efforts.
空气污染暴露会导致与心血管疾病相关的死亡和发病，包括中风。然而，很少有研究调查与空气污染相关的全球中风负担。本研究旨在评估 1990 年至 2021 年期间与空气污染相关的全球中风发病率和死亡率。
利用全球疾病负担研究 (GBD) 2021 年的数据，报告了全球与空气污染相关的中风导致的死亡人数和年龄标准化率 (ASR) 以及残疾调整生命年 (DALY)。进一步进行了年龄、性别、地区和国家以及中风亚型的亚组分析。线性回归模型探讨了全球时间趋势，聚类分析则探讨了 GBD 地区的时间趋势。为了预测到 2040 年的趋势，应用了年龄-时期-队列 (APC) 模型和贝叶斯年龄-时期-队列 (BAPC) 模型。
2021 年，与空气污染相关的中风导致的死亡人数为 1989686（95%置信区间 [95%UI]，1530479-2493238），残疾调整生命年 (DALY) 为 44962167（95%UI，35020339-55467024）。ASR 随年龄增长而增加，通常在 85 岁以上达到峰值。男性、中非地区和几内亚比绍的中风负担更高。脑内出血是最致命的亚型，其死亡率的 ASR 为 11.69（95%UI 8.94-14.69），残疾调整生命年的 ASR 为 276.93（95%UI 212.21-344.36）。1990 年至 2021 年，全球中风负担的粗死亡率和 DALY 分别增加了 13.4%和 6.3%，但标准化后呈下降趋势。亚洲和非洲的大多数 GBD 地区与空气污染相关的中风负担呈上升趋势，而欧洲和美洲则呈下降趋势。预测表明，ASR 逐渐降低，2020 年至 2040 年男性的比率更高。
尽管到 2021 年为止呈下降趋势，但与空气污染相关的全球中风负担仍然显著。尽管未来预测显示有所减少，但中风负担的粗计数仍然很大，且存在显著的区域差异。这需要实施公共卫生政策和持续努力。
