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. 2025 Apr 28;25(1):1567.
doi: 10.1186/s12889-025-22287-1.

An analysis of trends in the burden of ischemic stroke caused by air pollution in China between 1990 and 2021

Zhengfeng Yu  1 , Xiuyun Zhang  2 , Xiaomei Fu  3 , Xuemin Jia  4 , Mingyan Ju  1 , Yuxuan Zhang  1 , Yuying Li  1 , Ying Yin  5 , Fanjie Liu  6
Affiliations

An analysis of trends in the burden of ischemic stroke caused by air pollution in China between 1990 and 2021

Zhengfeng Yu et al. BMC Public Health. .

Abstract

Background: This study evaluates the burden of ischemic stroke attributable to air pollution in China from 1990 to 2021, examines gender and age-specific differences, and projects future disease burden trends from 2022 to 2036. By analyzing the impact of air pollution on ischemic stroke, this study aims to provide insights for public health policies and preventive measures.

Methods: Utilizing data from the 2021 Global Burden of Disease (GBD) study, this research examined the ischemic stroke burden associated with air pollution in China. To assess historical trends and project disease burden from 2022 to 2036, Joinpoint regression modeling and decomposition analysis were employed. These methods allow for identifying significant trend changes and disentangling the contributions of various factors.

Results: From 1990 to 2021, China observed a decline in both age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates for ischemic stroke attributed to air pollution. However, the decline was slower among men than women, with a higher burden observed in elderly males. Epidemiological transitions, including improved healthcare and lifestyle changes, were the main drivers behind the overall reduction in disease burden. Projections indicate that over the next 15 years, ASMR and age-standardized DALY rates (ASDR) for women will continue to decline, while ASMR for men is expected to rise and ASDR for men will gradually increase before stabilizing.

Conclusion: Elderly males are disproportionately affected by ischemic stroke related to air pollution, highlighting a critical public health issue. To mitigate this burden, it is essential for the government to implement targeted, gender- and age-specific policies aimed at improving air quality, enhancing healthcare access, and promoting preventive measures for vulnerable populations, particularly the elderly and men. These findings underscore the need for integrated strategies to reduce health disparities and address the ongoing challenges posed by air pollution.

Keywords: ASDR; ASMR; Air pollution; DALY; Global burden of disease; Ischemic stroke.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The GBD data used in our analysis was obtained from publicly available websites. No human or animal experiments, observations, or interventions were conducted as part of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The burden of ischemic stroke deaths and DALYs caused by air pollution in China in 1990 and 2021, by age and gender (A), (B) Number of deaths (C), (D) Number of DALYs
Fig. 2
Fig. 2
The burden of ischemic stroke deaths and DALYs rates caused by air pollution in China in 1990 and 2021, by age and gender (A), (B) mortality rate (C), (D) DALYs rate
Fig. 3
Fig. 3
Joinpoint regression analysis was applied to assess the ASMR and ASDR associated with ischemic stroke due to air pollution in China between 1990 and 2021. A The analysis encompasses the overall ASMR, as well as the ASMR for females and males. B Additionally, it includes the overall ASDR and the corresponding ASDR for females and males
Fig. 4
Fig. 4
The analysis decomposes the changes in DALYs and deaths resulting from ischemic stroke due to air pollution in China from 1990 to 2021, factoring in the contributions of aging (yellow), epidemiological changes (green), and population growth (orange). The black dots signify the total effect of these factors. A Gender-based decomposition of DALYs changes: male and female. B Gender-based decomposition of mortality changes: male and female
Fig. 5
Fig. 5
The projected burden of ischemic stroke in Chinese men and women due to air pollution from 2022 to 2036 (A), (C) ASMR (B), (D) ASDR
See this image and copyright information in PMC

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