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. 2025 Aug 4;15(1):28388.
doi: 10.1038/s41598-025-13893-5.

Stroke burden analysis attributable to ambient and household PM2.5 in China from 1990 to 2021 based on GBD 2021

Wanghong Su  1 , Chenran Zhang  1 , Huijuan Xi  1 , Jia Lv  1   2 , Shaoru Li  1   2 , Hongmei Xu  3 , Yue Cheng  4   5 , Bei Han  6   7
Affiliations

Stroke burden analysis attributable to ambient and household PM2.5 in China from 1990 to 2021 based on GBD 2021

Wanghong Su et al. Sci Rep. .

Abstract

Driven by rapid urbanization and economic growth, PM2.5 pollution has emerged as a pressing issue exacerbating the stroke burden, especially in developing nations such as China. As a preventable and measurable risk factor, the stroke burden attributable to ambient and household PM2.5 has not yet received adequate attention. The data were collected from Global Burden of Disease (GBD) database from 1990-2021.The disease burdens (death, DALYs, YLLs and YLDs) of three subtypes of stroke, including intracerebral hemorrhage (ICH), ischemic stroke (IS) and subarachnoid hemorrhage (SAH), attributable to ambient and household PM2.5 by gender and age groups were explored. Jointpoint regression was employed to calculate annual average percentage changes (AAPCs). And the disease burden was predicted by Bayesian age-period-cohort (BAPC) model. The death, DALY, and YLL number of ICH and IS attributable to both ambient and household PM2.5 were the main components of the total stroke burden globally and in China, with ICH being higher than IS. From 1990 to 2021, the overall number of stroke burdens was increased with increasing ambient PM2.5 exposure. The AAPC changes of ASDR, ASR and YLL standardized rates for ICH and IS in China peaked at ages of 55-59. The ASDRs of ICH and IS attributable to ambient PM2.5 were slowly increased in the next 25 years, approximately final doubling from 2021. The stable and increasing burden of stroke suggests that effective measures of ambient and household PM2.5 should be continuously strengthened by the Chinese and global governments jointly for specific populations, especially middle-aged and elderly people in China.

Keywords: Ambient pollution; China; GBD; Household air pollution; PM2.5; Stroke.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The number of DALYs of stroke attributable to ambient and household PM2.5 globally (a) and in China (b) from 1990 to 2021.
Fig. 2
Fig. 2
The change of ASDR (a, c, e, g) and YLDRs (b, d, f, h) per 100, 000 population of stroke attributable to ambient and household PM2.5 globally (a-d) and in China (e-f) from 1990 to 2021.
Fig. 3
Fig. 3
The changes (%) of AAPC in people among different age groups in ASDR of stroke attributable to ambient and household PM2.5 globally (a-c) and in China (d-f) from 1990 to 2021.
Fig. 4
Fig. 4
Historical trends and future projections in age-standardized disability-adjusted life year rate (ASDR) per 100,000 population of stroke burden attributable to ambient and household PM2.5 from 1990 to 2050 in China.
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