Data Sheet 6_Global patterns and trends in ischemic stroke burden attributable to particulate matter pollution: changes from 1990 to 2021 and projections from 2022 to 2050.pdf

BackgroundStroke was the third leading cause of global deaths in 2021, linked to air pollution, especially particulate matter (PMP). Research shows that ischemic strokes are more affected by air pollution than hemorrhagic strokes. This study aims to evaluate the disease burden, trends, and future projections of ischemic stroke associated with PMP using the latest data.
MethodsWe used data from the 2021 Global Burden of Disease study to analyze the burden of ischemic stroke attributable to PMP from 1990 to 2021. Joinpoint regression was used to assess the trends (Average Annual Percentage Change, AAPC). Meanwhile, the Bayesian Age – Period – Cohort modeling method was used to project the burdens until 2050.
ResultsGlobally, PMP-related ischemic stroke caused 905,600 deaths and 18.3 million DALYs in 2021, the highest levels in the past three decades PMP-related ischemic stroke deaths increased by 32.94% (1990–2021), yet ASDR declined by 46.65% (AAPC: −2.09, 95% CI: −2.45 to −1.72). Ambient particulate matter pollution (APMP) accounted for 66.6% of the burden in 2021 (vs. 45.9% in 1990), disproportionately affecting middle- and high-SDI regions. Conversely, household air pollution (HAP)-related burden declined but remained concentrated in low-SDI regions (80–82.5% in 2021). East Asia, South Asia, and Southeast Asia bore the highest absolute burdens, while Western Europe achieved the steepest ASR declines (AAPC for deaths: −6.55%). Projections to 2050 indicate rising ASRs. There was a negative correlation between SDI and ASRs, with APMP rising in middle-SDI nations and HAP persisting in low-SDI areas. Significant gender differences exist in the disease burden of PMP – induced ischemic stroke. Males generally have higher mortality rates and DALYs than females across most age groups, and the peak male mortality has been delayed over the past 30 years.
ConclusionThis global analysis underscores the urgent need for targeted pollution control strategies to address the dual burden of ischemic stroke driven by APMP in high- and middle-income regions and HAP in low-resource settings, emphasizing the critical role of tailored interventions to mitigate health disparities and achieve sustainable development goals.

背景：2021年，脑卒中是全球第三大死亡原因，其发生与空气污染密切相关，尤以颗粒物（PMP）为甚。研究表明，与出血性脑卒中相比，缺血性脑卒中受空气污染的影响更为显著。本研究旨在利用最新数据，评估与颗粒物（PMP）相关的缺血性脑卒中的疾病负担、变化趋势及未来预测情况。
方法：本研究采用2021年全球疾病负担（Global Burden of Disease, GBD）研究的数据，分析1990年至2021年间归因于颗粒物（PMP）的缺血性脑卒中疾病负担。采用连接点回归分析评估其变化趋势，即平均年度变化百分比（Average Annual Percentage Change, AAPC）。同时，采用贝叶斯年龄-时期-队列建模方法，对2050年之前的疾病负担进行预测。
结果：2021年，全球范围内与颗粒物（PMP）相关的缺血性脑卒中导致905600例死亡以及1830万伤残调整寿命年（Disability-Adjusted Life Years, DALYs），达到过去三十年来的最高水平。1990年至2021年间，与PMP相关的缺血性脑卒中死亡人数增长了32.94%，但年龄标准化死亡率（Age-Standardized Death Rate, ASDR）下降了46.65%（AAPC：-2.09，95%置信区间：-2.45至-1.72）。2021年，环境颗粒物污染（APMP）贡献了66.6%的疾病负担（1990年该比例为45.9%），其负担不成比例地集中在中、高社会人口学指数（Socio-demographic Index, SDI）地区。与之相反，室内空气污染（HAP）相关的疾病负担有所下降，但仍集中在低SDI地区（2021年占比80%~82.5%）。东亚、南亚及东南亚地区的绝对疾病负担最高，而西欧地区的年龄标准化率（ASR）降幅最大（死亡数的AAPC：-6.55%）。至2050年的预测结果显示，年龄标准化率将呈上升趋势。社会人口学指数（SDI）与年龄标准化率（ASR）呈负相关：中等SDI国家的环境颗粒物污染（APMP）相关负担持续上升，而低SDI地区的室内空气污染（HAP）相关负担依然存在。颗粒物（PMP）诱导的缺血性脑卒中疾病负担存在显著的性别差异：在大多数年龄组中，男性的死亡率及伤残调整寿命年（DALYs）均高于女性，且过去30年间男性死亡率的峰值出现时间有所延后。
结论：本项全球分析强调，亟需制定针对性的污染防控策略，以应对高、中等收入地区由环境颗粒物污染（APMP）驱动以及低收入地区由室内空气污染（HAP）引发的缺血性脑卒中双重负担；同时强调了制定个性化干预措施的关键作用，以缩小健康差距并实现可持续发展目标。