Table 5_Global burden, trends and health inequalities of stroke attributable to household air pollution, 1990–2021: a decomposition and prediction analysis.docx

ObjectiveExposure to household air pollution from solid fuels (HAP) increases stroke risk, affecting approximately 3 billion people worldwide and posing a significant challenge to public health. This study assessed trends in the HAP-related global stroke burden from 1990 to 2021 and quantified associated health inequalities.
MethodsData on HAP-attributable stroke disability-adjusted life years (DALYs) and deaths from 1990 to 2021 at global, regional, and national levels were derived from the Global Burden of Disease (GBD) 2021. The estimated annual percentage change (EAPC) was employed to evaluate temporal trends. Decomposition analysis elucidated the primary drivers of burden changes. Cross-country inequality was examined by incorporating the Sociodemographic Index (SDI), and future disease burden was projected.
ResultsFrom 1990 to 2021, the age-standardized rates (ASR) of DALYs and deaths from HAP-related stroke declined globally, although significant geographic heterogeneity persisted. Compared with high SDI regions, lower SDI areas bore a heavier burden, with countries such as Zimbabwe and Lesotho experiencing the most notable increases. Furthermore, the share of global ischemic stroke burden increased, whereas intracerebral hemorrhage remained the dominant contributor. Decomposition analysis revealed that population growth consistently served as the main driver of burden increases in low-middle and low SDI areas. Notably, stroke burden was disproportionately concentrated in lower SDI nations, especially for the subarachnoid hemorrhage subtype. Projections suggested that by 2035, the global HAP-related stroke burden would increase, with the ischemic stroke subtype exhibiting the greatest growth.
ConclusionAlthough the global HAP-related stroke burden has reduced, significant regional and population disparities persist, along with severe health inequities. Therefore, emphasis should be placed on improving household energy supply and healthcare resource allocation in low-development regions to reduce preventable health inequities.

【研究目的】固体燃料所致室内空气污染（household air pollution from solid fuels，HAP）会增加脑卒中发病风险，全球约有30亿人群受此影响，对公共卫生构成严峻挑战。本研究旨在分析1990年至2021年与HAP相关的全球脑卒中疾病负担变化趋势，并量化相关健康不公平性。
【研究方法】本研究从2021年全球疾病负担（Global Burden of Disease，GBD）研究中提取了1990年至2021年全球、区域及国家层面上，与HAP相关的脑卒中所致伤残调整生命年（disability-adjusted life years，DALYs）及死亡人数数据。采用估计年度百分比变化（estimated annual percentage change，EAPC）评估时间变化趋势，通过分解分析阐明疾病负担变化的主要驱动因素。结合社会人口学指数（Sociodemographic Index，SDI）分析国家间健康不公平性，并对未来疾病负担进行预测。
【研究结果】1990年至2021年，全球范围内与HAP相关的脑卒中所致伤残调整生命年及死亡人数的年龄标化率（age-standardized rates，ASR）均呈下降趋势，但仍存在显著的地域异质性。与高SDI区域相比，低SDI区域的疾病负担更重，津巴布韦、莱索托等国家的负担增幅最为显著。此外，全球缺血性脑卒中（ischemic stroke）疾病负担占比有所上升，而脑出血（intracerebral hemorrhage）仍为主要贡献类型。分解分析显示，人口增长始终是中低及低SDI区域疾病负担上升的主要驱动因素。值得注意的是，脑卒中疾病负担高度集中于低SDI国家，尤以蛛网膜下腔出血（subarachnoid hemorrhage）亚型为甚。预测结果表明，到2035年，全球与HAP相关的脑卒中疾病负担将有所上升，其中缺血性脑卒中亚型的增幅最大。
【研究结论】尽管全球与HAP相关的脑卒中疾病负担已有所下降，但仍存在显著的区域及人群差异，同时伴随严重的健康不公平性。因此，应重点改善低发展水平地区的家用能源供应与医疗资源配置，以减少可避免的健康不公平现象。