The burden of ischemic stroke due to air pollution in ten European countries

BACKGROUND: Stroke is one of the leading causes of disability worldwide and there are many reports that the higher risk of ischemic stroke is associated with air pollution. It is noted that the adverse effects of air pollution on health are still invisible and not enough communicated to patients and health professionals. METHODS: Within the European Burden of Disease Network (COST Action CA18218), we analyzed Disability-Adjusted Life-Years (DALY) rates associated with ischemic stroke per 100,000 among all ages attributable to air pollution. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates per 100,000 ischemic strokes in 2019: Bulgaria, North Macedonia, Montenegro, Georgia, Serbia, Romania, Ukraine, Russian Federation, Bosnia and Herzegovina and Latvia. RESULTS: The highest DALY rate per 100,000 ischemic strokes was in Bulgaria (7016.81), followed by North Macedonia (5773.40), Montenegro (5119.61), and Georgia (4967.42). The highest DALY rate attributable to air pollution was in North Macedonia (1462.61), followed by Bulgaria (1240.13), Montenegro (1052.21), and Serbia (1037.41). The highest percentage of ischemic stroke attributable to air pollution was in Bosnia and Herzegovina (25.66%), North Macedonia (25.32%), Serbia (21.23%), and Montenegro (20.55%). CONCLUSIONS: Air pollution is a significant contributable factor in the prevalence of ischemic stroke. In observed countries, more than 20% of the ischemic stroke burden is attributable to air pollution. The highest DALY rate attributable to air was in Balkan countries. KEY MESSAGES: • The highest DALY and the highest percentage of ischemic stroke attributable to air pollution were in Balkan countries. • There is an emerging need for public health regulations and policies in order to reduce air pollution and stroke.