Stroke Mortality Attributable to Ambient Particulate Matter Pollution from 1990 to 2015 in China: An Age-Period-Cohort and Spatial Autocorrelation Analysis

In this study, we analyzed the temporal and spatial variations of stroke mortality attributable to ambient particulate matter pollution (stroke mortality-PM(2.5)) 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-PM(2.5) 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-PM(2.5) 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-PM(2.5) had significantly declined from 2005 to 2015 due to socio-economic and healthcare development. Stroke mortality-PM(2.5) varied substantially among different regions, and cost-effective prevention and control should be implemented more in the middle and southwestern areas of China.