Table_1_Time trends in the burden of stroke and subtypes attributable to PM2.5 in China from 1990 to 2019.XLSX

BackgroundIncreasing studies have found that PM2.5 has large adverse effects on stroke mortality. We want to investigate the long-term trends in the mortality of stroke attributable to ambient particulate matter pollution and household air pollution to provide evidence facilitating the design of policy.
MethodsThe deaths data of stroke and its subtypes attributable to PM2.5 were obtained from the Global Burden of Disease (GBD) 2019, analyzed by Joinpoint regression software and the age-period-cohort (APC) method to assess the magnitude of the trends in mortality and the temporal trends in the mortality rate by age, period, and cohort.
ResultsFrom 1990 to 2019, the age-standardized mortality rate (ASMR) attributable to PM2.5 exposure trended downwards, but the trends of ambient particulate matter pollution and household air pollution were opposite. The trends varied among subtypes, the AAPC of intracerebral hemorrhage, ischemic stroke, and subarachnoid hemorrhage attributable to PM2.5 were 0.7, 2.5, and−3.3%, respectively. The longitudinal age curve of the APC model showed that the mortality rates due to PM2.5 exposure increased with age. The period RRs of ischemic stroke due to ambient particulate matter pollution increased significantly. The cohort RRs of ambient particulate matter pollution increased among those born from 1905 to 1990. The net drifts of all subtypes attributable to PM2.5 were below 0, but owing to the increase of ambient particulate matter pollution, the range of the decline was small. Males had higher net drift values, compared with females.
ConclusionsAmbient particulate matter pollution has become the main type of PM2.5 leading to stroke in China. PM2.5 exposure is more harmful to ischemic stroke, males, and elderly. Chinese government should pay attention to the long-term impact of ambient air pollution on stroke and take effective public health policies and interventions.

**研究背景**：越来越多的研究表明，细颗粒物（PM2.5）对脑卒中死亡率具有显著不良影响。本研究旨在探究环境颗粒物污染与家庭空气污染所致脑卒中死亡率的长期变化趋势，为政策制定提供科学依据。

**研究方法**：本研究从2019年全球疾病负担（Global Burden of Disease, GBD）数据库中获取细颗粒物（PM2.5）所致脑卒中及其亚型的死亡数据，采用连接点回归（Joinpoint regression）软件与年龄-时期-队列（APC）分析法，评估死亡率变化趋势的幅度，并按年龄、时期及队列分析死亡率的时间变化趋势。

**研究结果**：1990年至2019年，细颗粒物（PM2.5）暴露所致的年龄标化死亡率（ASMR）呈下降趋势，但环境颗粒物污染与家庭空气污染所致的死亡率变化趋势恰好相反。不同脑卒中亚型的变化趋势存在差异：细颗粒物（PM2.5）所致的脑出血、缺血性脑卒中及蛛网膜下腔出血的平均年度百分比变化（AAPC）分别为0.7%、2.5%及-3.3%。年龄-时期-队列（APC）模型的纵向年龄曲线显示，细颗粒物暴露所致的死亡率随年龄增长而升高。环境颗粒物污染所致缺血性脑卒中的时期相对危险度（RR）显著升高。1905年至1990年出生人群中，环境颗粒物污染所致的队列相对危险度（RR）呈上升趋势。细颗粒物所致各脑卒中亚型的净漂移值均小于0，但受环境颗粒物污染上升的影响，死亡率的下降幅度较小。与女性相比，男性的净漂移值更高。

**研究结论**：在我国，环境颗粒物污染已成为细颗粒物（PM2.5）导致脑卒中的主要来源。细颗粒物暴露对缺血性脑卒中、男性及老年人群的危害更为显著。我国政府应重视环境空气污染对脑卒中的长期影响，制定并实施有效的公共卫生政策与干预措施。