Abstract
In this study, we analyzed the temporal and spatial variations of stroke mortality attributable to ambient particulate matter pollution (stroke mortality-PM2.5) in China from 1990 to 2015. Data were collected from the Global Burden of Disease (GBD) 2015 study and analyzed by an age-period-cohort model (APC) with an intrinsic estimator (IE) algorithm, as well as spatial autocorrelation based on the Geographic Information System. Based on APC analysis with the IE method, stroke mortality-PM2.5 increased exponentially with age, its relative risk reaching 42.85 (95% CI: 28.79, 63.43) in the 75–79 age group. The period effects showed a reversed V-shape and its highest relative risk was 1.22 (95% CI: 1.15, 1.27) in 2005. The cohort effects decreased monotonically from 1915–1919 to 1990–1994. The change rate fluctuated from 1920–1924 to 1990–1994, including three accelerating and three decelerating decreases. There was a positive spatial autocorrelation in stroke mortality-PM2.5 from 1990 to 2015. Hot-spots moved from the northeastern areas to the middle and southwestern areas, whereas cold-spots lay mostly in coastal provinces. Besides the aging process in recent years, stroke mortality-PM2.5 had significantly declined from 2005 to 2015 due to socio-economic and healthcare development. Stroke mortality-PM2.5 varied substantially among different regions, and cost-effective prevention and control should be implemented more in the middle and southwestern areas of China.
Highlights
Non-communicable diseases (NCDs), which accounted for approximately 71.3% of global deaths in 2015, are recognized as a major burden on public health [1]
Because of the linear relationship among the age, period and cohort, for age = period − cohort, it was hard for the traditional age-period-cohort model (APC) model to estimate the net effect for each age, period and cohort effects [19], which could be exhibited by linear Equation (1): Yj = μ + α × age j + β × period j + γ × cohort j + ε i where YJ denoted the response variable—the net effect on stroke mortality-PM2.5 for group j, α, β and γ denoted the coefficient of age, period and cohort of APC model, respectively, and μ denoted the intercept of the model. ε i denoted the residual of the APC model
age-standardized mortality rates (ASMRs) were higher than crude mortality rates (CMRs) for the period from 1990 to 2015 and tended to be equal in 2015
Summary
Non-communicable diseases (NCDs), which accounted for approximately 71.3% of global deaths in 2015, are recognized as a major burden on public health [1]. As the second-leading cause of death globally, stroke caused approximately 6.33 million deaths and 118.63 million disability-adjusted life years (DALYs) in 2015, and three-quarters of them occurred in developing countries [2,3]. Stroke ranked the first leading cause of death in China, having caused 1.90 million deaths and. 34.81 million DALYs in 2015, and has brought a tremendous health burden to society [4]. It was widely reported that stroke had many risk factors, including high blood pressure, unhealthy diet (high sodium or/and vitamin deficiencies), smoking, lack of exercise, and air pollution [5,6]. Air pollution is a major threat to health worldwide. As an important type of air pollutant, ambient particulate matter pollution
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