Spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels in 204 countries and territories from 1990 to 2019

Abstract

Exposure to household air pollution from solid fuels (HAP) is associated with stroke. However, few studies have assessed stroke burden attributable to HAP globally and made comparisons across countries. We aimed to estimate the spatiotemporal trends in stroke burden and mortality attributable to household air pollution from solid fuels (HAP) in 204 countries and territories from 1990 to 2019. Data on stroke burden and mortality attributable to HAP from 1990 to 2019 were obtained from Global Burden of Disease Study 2019. We estimated the numbers and age-standardized rates (ASRs) of stroke disability-adjusted life years (DALYs) and mortality (ASDR and ASMR) by sex, age, and subtype, at global, regional, and national levels. Estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends in ASDR and ASMR from 1990 to 2019. In 2019, globally, 14.7 million DALYs and 0.6 million deaths were caused by stroke attributable to HAP. The corresponding ASDR and ASMR increased with age, were highest in males and for intracerebral hemorrhage, with highest ASRs in the low sociodemographic index (SDI) regions and Solomon Islands, and varied greatly at the national level. From 1990 to 2019, the corresponding EAPCs in ASDR and ASMR were -4.00 (95% confidence interval [CI]: -4.21 to -3.80) and -4.12 (95% CI: -4.37 to -3.87), respectively. Stroke burden attributable to HAP decreased in all age groups. Females had a lower decreasing trend in ASDR and ASMR, compared with males. The decline was more significant for subarachnoid hemorrhage, while proportions of ischemic stroke in the numbers of stroke burden increased worldwide and in all SDI regions. Although most of countries and territories were in a decreasing trend in ASRs over the past three decades, Zimbabwe and Philippines showed an undesirable increased trend. Stroke burden attributable to HAP is still pronounced in males, old-age populations, low-income countries, and for intracerebral hemorrhage. Despite its decreasing spatiotemporal trends in most countries, continued efforts on HAP control are needed to reduce related stroke burden, especially in those countries with increased trends.

Keywords: Disability-adjusted life years (DALYs); Household air pollution; Mortality; Solid fuels; Stroke.