Table 2_Spatiotemporal trends of ischemic stroke burden attributable to PM2.5 from 1990 to 2021.xlsx

BackgroundTo evaluate the spatiotemporal variation in ischemic stroke attributed to particulate matter 2.5 (PM2.5) on global, regional, and national scales from 1990 to 2021 is essential for mitigating air pollution and controlling ischemic stroke.
MethodsThe death and disability-adjusted life years (DALYs) were extracted from the Global Burden and Disease Study (GBD) 2021. We utilized joinpoint regression and decomposition analysis to assess PM2.5 exposure and pinpoint high-risk areas.
ResultsIn 2021, PM2.5 caused approximately 0.90 million mortality and 18.29 million DALYs due to ischemic stroke worldwide. The age-standardized rates (ASRs) of ischemic stroke linked to ambient PM2.5 slightly declined, while those associated with household PM2.5 significantly decreased over the past 32 years. The burden of ischemic stroke attributable to ambient and household PM2.5 exhibited considerable heterogeneity across 204 countries. Household PM2.5 significantly affected ischemic stroke burdens in low Socio-demographic indices (SDI) regions, whereas ambient PM2.5 had a greater impact in middle, high-middle, and high SDI regions. In the regions with an SDI below 0.7, including Southern Sub-Saharan Africa and East, South, and Southeast Asia, there was a positive correlation between SDI and ASRs linked with ambient PM2.5. Notably, in the 65–95 age group, the age-specific rates associated with ambient PM2.5 showed a substantial decline among females, while the rates for males remained relatively stable.
ConclusionOur results presented that PM2.5 significantly affects global ischemic stroke burden, particularly among the male population and in low SDI regions. It highlighted the urgency of integrating PM2.5 reduction strategies with ischemic stroke prevention programs.

背景 评估1990年至2021年全球、区域及国家尺度下细颗粒物2.5（particulate matter 2.5，PM2.5）所致缺血性脑卒中（ischemic stroke）的时空变异特征，对于大气污染防控与缺血性脑卒中防治均具有重要意义。
方法 数据提取自2021年全球疾病负担研究（Global Burden and Disease Study, GBD）中的死亡人数与伤残调整寿命年（disability-adjusted life years, DALYs）。本研究采用分段回归（joinpoint regression）与分解分析方法，对PM2.5暴露情况进行评估，并精准定位高风险区域。
结果 2021年，全球范围内PM2.5所致缺血性脑卒中死亡人数约为90万，伤残调整寿命年达1829万。过去32年间，与环境PM2.5相关的缺血性脑卒中年龄标化率（age-standardized rates, ASRs）小幅下降，而与家庭PM2.5相关的年龄标化率则显著降低。204个国家中，环境与家庭PM2.5所致缺血性脑卒中负担存在显著异质性。家庭PM2.5对低社会人口学指数（Socio-demographic indices, SDI）区域的缺血性脑卒中负担影响显著，而环境PM2.5则对中、中高及高SDI区域的影响更大。在SDI低于0.7的区域，包括撒哈拉以南非洲南部、东亚、南亚及东南亚地区，SDI与环境PM2.5相关的年龄标化率呈正相关关系。值得注意的是，在65~95岁年龄组中，与环境PM2.5相关的年龄别死亡率在女性群体中大幅下降，而男性群体的该指标则保持相对稳定。
结论 本研究结果表明，PM2.5对全球缺血性脑卒中负担存在显著影响，尤其在男性群体与低SDI区域更为突出。本研究凸显了将PM2.5减排策略与缺血性脑卒中预防方案相结合的紧迫性。