Impact of exposure of particulate matters on stroke risk: exploring the influence of physical activity among middle-aged and older adults in China

Abstract

Background: Particulate matter is increasingly recognized as a critical environmental risk factor for stroke, particularly among older populations. Although physical activity confers substantial cerebrovascular benefits, it remains unclear how it might mediate or moderate the adverse influence of different sizes of particulate matter on stroke risk.

Methods: A prospective cohort analysis was conducted using data from the China Health and Retirement Longitudinal Study, which enrolled adults aged ≥45 years from diverse regions across mainland China. Annual mean concentrations of PM₁, PM_2.5, and PM₁₀ were estimated from 2010 to 2020 based on geocoded residential information. Incident stroke cases were identified through self-reported diagnoses and hospitalization records. Binary logistic mixed-effect models examined the associations between exposures to PM₁, PM_2.5, and PM₁₀, respectively, and stroke risk. Subgroup and mediation analyses explored the roles of physical activity, gender, and job status.

Results: Of 13,573 participants, 540 (4.0%) experienced an incident stroke during follow-up. After full adjustment for covariates, each 10 μg/m3 increment in PM₁, PM_2.5, and PM₁₀ was significantly associated with higher stroke odds (odds ratios = 1.08, 1.05, and 1.04, all P < 0.01). Stronger relationships were observed among physically inactive individuals, women, and those who were unemployed or engaged in agricultural work. Mediation analysis indicated that physical activity accounted for ~19.6% of the detrimental effect of elevated PM_2.5 on stroke likelihood, suggesting that reduced engagement in physical activity constitutes an important pathway through which finer particulate pollution exerts its harmful impact.

Conclusions: Greater exposure to PM₁, PM_2.5, and PM₁₀ substantially elevates the risk of stroke among middle-aged and older adults in China, especially in subgroups characterized by lower levels of physical activity and socioeconomic disadvantage. Physical activity partially mediates the effect of PM_2.5 on stroke risk, underscoring the need for integrated public health interventions that address both environmental pollution and modifiable lifestyle factors. Future studies utilizing high-resolution exposure assessments and objective health measures could further elucidate causal mechanisms and guide strategies to mitigate pollution-related stroke.

Keywords: China; middle-aged and older adults; particulate matters; physical activity; stroke.

Figure 1

The detailed screening process of selecting the participants of the study for the impact of exposure of particulate matters on stroke risk. PA, physical activity.

Figure 2

Forest plot of the association between particulate matter (PM₁^**, PM_2.5^**, and PM₁₀^*) and stroke risk. ^**P < 0.001; ^*P < 0.01.

Figure 3

The natural cubic spline analyses of the annual mean concentrations of particulate matters (PM₁, PM_2.5, and PM₁₀) and stroke risk.

Figure 4

Path diagram of mediation analysis of the relationship between PM_2.5, physical activity, and stroke risk.