Neurol Sci. 2026 Jul 22;47(8):652. doi: 10.1007/s10072-026-09261-4.
ABSTRACT
BACKGROUND: Fine particulate matter (PM2.5) is a modifiable risk factor for stroke, yet the long-term trajectory of PM2.5-attributable hemorrhagic stroke in China-and its standing among G20 nations-remains inadequately characterized. We quantified this burden (1990-2023), examined its drivers, and projected trends through 2050.
METHODS: Using Global Burden of Disease 2023 data, we analyzed PM2.5-attributable hemorrhagic stroke deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We evaluated temporal trends using estimated annual percentage changes (EAPCs), quantified demographic and epidemiological drivers via decomposition analysis, and projected future burden using Bayesian age-period-cohort models.
RESULTS: In 2023, China remained among the most heavily burdened G20 nations, with the burden disproportionately concentrated in older males. From 1990 to 2023, China's age-standardized death and YLL rates declined steeply (EAPCs: -3.93 and - 4.18), whereas the YLD rate declined more modestly (EAPC: -1.29). Decomposition revealed that substantial epidemiological improvements successfully offset the upward pressure driven by rapid population aging and growth. Projections to 2050 indicate that while mortality metrics will continue declining, the disability (YLD) trajectory remains highly uncertain.
CONCLUSIONS: Despite severe demographic headwinds, China achieved substantial reductions in PM2.5-attributable hemorrhagic stroke mortality. The divergence between the steep decline in age-standardized mortality and the more modest decline in the age-standardized disability burden is consistent with several non-mutually-exclusive hypotheses, including improved acute survival that increases the surviving pool of disabled patients, changes in case-mix and disability ascertainment, and slower progress in post-stroke rehabilitation; the ecological design of this study does not permit these mechanisms to be distinguished. Sustaining progress requires combining strict environmental PM2.5 control with strategically expanded post-stroke rehabilitation capacity.
PMID:42484721 | DOI:10.1007/s10072-026-09261-4