Wu Erman, Su Riqing, Tang Tong, Li Jiakun, Mijiti Maimaitili, Li Yandong, Zhang Gaocai, Lian Minghao, Zhang Yongtao, Zhu Guohua, Geng Dangmurenjiafu
Neurosurgery Center of the First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, China.
Department of Computer Science and Information Technologies, Elviña Campus, University of A Coruña, A Coruña, Spain.
Front Public Health. 2025 Jun 26;13:1599541. doi: 10.3389/fpubh.2025.1599541. eCollection 2025.
Stroke was the third leading cause of global deaths in 2021, linked to air pollution, especially particulate matter (PMP). Research shows that ischemic strokes are more affected by air pollution than hemorrhagic strokes. This study aims to evaluate the disease burden, trends, and future projections of ischemic stroke associated with PMP using the latest data.
We used data from the 2021 Global Burden of Disease study to analyze the burden of ischemic stroke attributable to PMP from 1990 to 2021. Joinpoint regression was used to assess the trends (Average Annual Percentage Change, AAPC). Meanwhile, the Bayesian Age - Period - Cohort modeling method was used to project the burdens until 2050.
Globally, PMP-related ischemic stroke caused 905,600 deaths and 18.3 million DALYs in 2021, the highest levels in the past three decades PMP-related ischemic stroke deaths increased by 32.94% (1990-2021), yet ASDR declined by 46.65% (AAPC: -2.09, 95% CI: -2.45 to -1.72). Ambient particulate matter pollution (APMP) accounted for 66.6% of the burden in 2021 (vs. 45.9% in 1990), disproportionately affecting middle- and high-SDI regions. Conversely, household air pollution (HAP)-related burden declined but remained concentrated in low-SDI regions (80-82.5% in 2021). East Asia, South Asia, and Southeast Asia bore the highest absolute burdens, while Western Europe achieved the steepest ASR declines (AAPC for deaths: -6.55%). Projections to 2050 indicate rising ASRs. There was a negative correlation between SDI and ASRs, with APMP rising in middle-SDI nations and HAP persisting in low-SDI areas. Significant gender differences exist in the disease burden of PMP - induced ischemic stroke. Males generally have higher mortality rates and DALYs than females across most age groups, and the peak male mortality has been delayed over the past 30 years.
This global analysis underscores the urgent need for targeted pollution control strategies to address the dual burden of ischemic stroke driven by APMP in high- and middle-income regions and HAP in low-resource settings, emphasizing the critical role of tailored interventions to mitigate health disparities and achieve sustainable development goals.
中风是2021年全球第三大死因，与空气污染有关，尤其是颗粒物（PMP）。研究表明，缺血性中风比出血性中风更容易受到空气污染的影响。本研究旨在利用最新数据评估与PMP相关的缺血性中风的疾病负担、趋势和未来预测。
我们使用了2021年全球疾病负担研究的数据，分析了1990年至2021年PMP导致的缺血性中风负担。采用Joinpoint回归评估趋势（平均年百分比变化，AAPC）。同时，使用贝叶斯年龄-时期-队列建模方法预测到2050年的负担。
2021年，全球与PMP相关的缺血性中风导致905,600人死亡，1830万伤残调整生命年，是过去三十年中的最高水平。与PMP相关的缺血性中风死亡人数增加了32.94%（1990 - 2021年），但年龄标准化死亡率（ASDR）下降了46.65%（AAPC：-2.09，95%CI：-2.45至-1.72）。2021年，环境颗粒物污染（APMP）占负担的66.6%（1990年为45.9%），对中高社会人口指数（SDI）地区的影响尤为严重。相反，与家庭空气污染（HAP）相关的负担有所下降，但仍集中在低SDI地区（2021年为80 - 82.5%）。东亚、南亚和东南亚的绝对负担最高，而西欧的年龄标准化发病率（ASR）下降幅度最大（死亡的AAPC为-6.55%）。到2050年的预测表明ASR将上升。SDI与ASR之间存在负相关，中SDI国家的APMP上升，低SDI地区的HAP持续存在。PMP诱发的缺血性中风的疾病负担存在显著的性别差异。在大多数年龄组中，男性的死亡率和伤残调整生命年通常高于女性，并且在过去30年中男性的死亡高峰有所延迟。
这项全球分析强调迫切需要有针对性的污染控制策略，以应对高收入和中等收入地区由APMP以及资源匮乏地区由HAP驱动的缺血性中风双重负担，强调了量身定制的干预措施在减轻健康差距和实现可持续发展目标方面的关键作用。
