Estimates, temporal evolution, and contributors of the stroke burden due to air pollution and non-optimal temperature across G20 nations, 1990-2023.

Background

Air pollution and non-optimal temperature are major modifiable environmental risk factors for stroke. This study assessed their attributable stroke burden across G20 countries from 1990 to 2023 and projected trends to 2040.

Methods

Using data from the GBD 2023, we analyzed age-standardized mortality (ASMR) and disability-adjusted life year rates (ASDR) for stroke attributable to air pollution (ambient particulate matter and household air pollution from solid fuels) and non-optimal temperature (high and low), and stratified according to the Socio-demographic Index (SDI). Joinpoint regression, decomposition analysis, and ARIMA modeling were employed.

Results

The ASMR for stroke attributable to these environmental risks in G20 countries declined from 52.81 (95% UI: 32.05-71.82) to 17.46 (95% UI: 10.58-24.53) per 100,000 from 1990 to 2023, with an estimated annual percentage change (EAPC) of -3.44% (95% CI: -3.57 to -3.30). The ASDR declined from 1,148.95 (95% UI: 693.62-1,576.02) to 394.91 (95% UI: 229.91-550.54) per 100,000 (EAPC: -3.29%, 95% CI: -3.41 to -3.17). This was driven by a sharp decrease in household air pollution burden. However, burdens attributable to ambient particulate matter and high temperature increased or remained stable, exhibiting marked geographical disparities, with low- and middle-SDI G20 nations bearing a disproportionately high burden. Projections to 2040 indicate a continued overall decline, but burdens attributable to ambient particulate matter and high temperature are expected to persist.

Conclusions

While progress has been made, ambient particulate matter pollution and high temperature remained important contributors to the estimated GBD-attributable stroke burden in the G20, underscoring the need for targeted intervention.