Jul 2026· Public Health Risk Assesment Journal· Vol 4, pp. 1-19· 0 citations· 54 references
Abstract
Background: Ambient particulate matter ≤2.5 μm (PM2.5) is a major environmental health risk contributing to global morbidity and mortality. Although its link with cardiovascular diseases is well established, evidence on the stroke burden attributable to PM2.5 exposure remains limited in Indonesia. Methods: This ecological study used Global Burden of Disease (GBD) 2021 data to analyze the association between PM2.5 exposure and stroke burden, including incidence, prevalence, and mortality, across 34 Indonesian provinces from 2011 to 2020. Age-standardized rates (ASRs) were assessed using a linear mixed model, with year as a repeated measure and province as a random effect to account for spatial and temporal variations. Findings: Mean PM2.5 concentrations ranged from 16.96 to 20.10 µg/m³, exceeding WHO and national air quality standards. Despite minor annual fluctuations in PM2.5, stroke mortality attributable to air pollution showed an increasing trend. Higher PM2.5 levels were significantly associated with ischemic stroke (IS) incidence (β = -0.117, p <0.001) and mortality (β = 0.152, p <0.001), as well as intracerebral hemorrhage (ICH) incidence (β = 0.017, p = 0.015), prevalence (β = 1.641, p <0.001), and mortality (β = 0.773, p = 0.004). The effect of PM2.5 exposure was greater for ICH than for IS. Conclusion: Long-term exposure to PM2.5 is significantly associated with stroke burden in Indonesia, particularly for ICH. Strengthening air quality management and stroke prevention policies is crucial, especially in high-risk regions. Novelty/Originality of this article: This study is the first to comprehensively assess the long-term association between PM2.5 and stroke subtypes using national-level GBD data across all Indonesian provinces, providing spatially and temporally robust evidence for public health policy in low- and middle-income tropical settings.
Fine particulate matter (PM2.5) pollution is a leading cause of the global mortality burden, but public health risks from short-term fluctuations, in addition to long-term exposure, have been insufficiently studied. Potentially influenced by climate change, the daily variability of PM2.5 has significantly increased over the past 60 years, particularly in densely populated regions of East Asia, South Asia, and western North America. To quantify the short-term mortality burden exacerbated by this growing variability, we developed a novel method, the Meta-Regression of Distributional Derivatives (MR-ODDs), to construct nonlinear exposure-response relationships from published summary statistics without requiring individual-level data. Using this approach, we estimate that an average of 672,867 (95% CI: 579,452–740,680) deaths per year globally were attributable to short-term PM2.5 exposure between 2000 and 2023. The mortality burden is especially pronounced in regions where intensifying climate variability drives more frequent extreme pollution events. Western North America, in particular, has emerged as the region with the fastest-rising risk from such events. These findings indicate that extreme pollution events pose a new and growing threat to global public health, demanding a shift in policy from managing annual average concentrations to focusing on early warning and intervention for extreme pollution peaks.
Jianyu Deng, Peng Zhou, Jinting Guo et al.· The Innovation Medicine· 0 citations
This study investigated the spatiotemporal variability of fine particulate matter (PM2.5) in Addis Ababa, Ethiopia and assessed its associated health risks and economic burden using data from January 2022 to December 2023. Hourly PM2.5 concentrations were collected through a hybrid monitoring network comprising seven low-cost sensors and two Beta Attenuation Monitors (BAM). Spatiotemporal analysis was performed using Python, and health risks were assessed by estimating the Hazard Quotient (HQ) and Excess Lifetime Cancer Risk (ELCR). The economic burden attributable to PM2.5 exposure was assessed by monetizing disease-specific Disability-Adjusted Life Years (DALYs) using a locally adapted Value of Statistical Life (VSL) approach. Over the two-year periods, mean PM2.5 concentrations ranged from 15 to 33 μg/m3 across monitoring sites, with an overall a citywide average of 27 μg/m3, exceeding the World Health Organization (WHO) Air Quality Guideline (AQG) of 5 μg/m3 by more than fivefold. Seasonal analysis revealed elevated PM2.5 concentrations during the wet season (Kiremt), while diurnal patterns showed peaks of 38 µg/m3 at 7:00 AM. The HQ values for all age groups exceeded the acceptable threshold of 1, indicating non-carcinogenic health risks. ELCR estimates calculated using a slope factor of 0.008 exceeded the risk threshold (1 ×10-4), whereas estimates based on the slope factor of 0.0012 remained within the acceptable limits, highlighting the sensitivity of cancer risk estimates to the toxicity parameter applied. The economic burden attributable to PM2.5 exposure was estimated at USD 652.95 million over the two-year study period, contributing an external cost share to national GDP of 0.25% in 2022 and 0.25% in 2023. Cardiovascular diseases, particularly ischemic heart disease (IHD), accounted for the largest share of economic losses, significantly exceeding acute respiratory infections and PM2.5 related cancers. These findings provide evidence to support targeted policies aimed at reducing PM2.5 related cancers combined.
Background: Fine particulate matter (PM2.5) remains a major environmental health concern, particularly in low- and middle-income countries. Nigeria experiences persistently high ambient PM2.5 exposure, yet long-term national evidence linking annual exposure patterns with broad population-health indicators remains limited.
Objective: To examine trends in population-weighted ambient PM2.5 exposure in Nigeria from 1990 to 2023 and assess ecological associations with life expectancy, under-five mortality, and crude death rate.
Methods: An ecological time-series study was conducted using 34 annual observations from the World Bank World Development Indicators. Population-weighted PM2.5 exposure was the principal exposure. Health outcomes were life expectancy, under-five mortality, and crude death rate. Urban population percentage and GDP per capita were included in sensitivity analyses. Descriptive statistics, linear trend models, Pearson correlations, ordinary regression diagnostics, and autoregressive integrated moving average (ARIMA) models were used.
Results: Mean PM2.5 exposure was 62.97 ± 5.22 µg/m³ and showed no significant linear trend over the study period (B = -0.016 µg/m³/year, p = .863). Life expectancy increased significantly, while under-five mortality and crude death rate declined significantly (all p < .001). Crude correlations between PM2.5 and the three health outcomes were not significant. Final ARIMA(1,2,0) models showed no significant PM2.5 association with under-five mortality (B = -0.003, p = .715), life expectancy (B = 0.008, p = .074), or crude death rate (B = -0.005, p = .108). Findings remained non-significant after adjustment for urbanisation and GDP per capita, and final model residual diagnostics were acceptable.
Conclusions: Nigeria experienced persistently high PM2.5 exposure alongside marked improvements in selected population-health indicators. Annual national PM2.5 variation did not independently explain these broad health outcomes after serial dependence was modelled. Stronger air-quality surveillance and more spatially resolved, disease-specific epidemiological studies are needed.
J. Kalu· IPS Journal of Public Health· 0 citations
Long-term exposure to ambient fine particulate matter (PM2.5) is the leading environmental risk factor for premature mortality worldwide, yet comprehensive province-level evidence quantifying its health burden across Türkiye remains limited. This study investigated the spatial relationship between long-term PM2.5 exposure and all-cause attributable mortality across all 81 Turkish provinces in 2022 using province-level annual mean PM2.5 concentrations and World Health Organisation (WHO) AirQ+ estimates of PM2.5-attributable deaths among adults aged ≥30 years, assuming a counterfactual concentration of 5 µg/m3. The association between PM2.5 exposure and mortality was evaluated using Pearson and Spearman correlation analyses, ordinary least squares (OLS) regression, a log–log elasticity model, and population-weighted regional and exposure-quartile comparisons, while national temporal indicators for 2010–2023 were reported solely as supplementary context for the primary single-year 2022 cross-sectional analysis. The population-weighted annual mean PM2.5 concentration was 27.0 µg/m3, exceeding the WHO Air Quality Guideline by a factor of 5.4, and all 81 provinces exceeded the recommended threshold. The bivariate OLS model accounted for 41% of the between-province variation in attributable mortality rates (OLS slope = 3.23 additional deaths per 100,000 population for each 1 µg/m3 increase in PM2.5; 95% CI: 2.37–4.10; R2 = 0.41; p < 0.001), while the log–log elasticity model indicated that a 1% increase in PM2.5 concentration was associated with a 0.80% increase in the attributable mortality rate (95% CI: 0.65–0.95). The attributable fraction of natural-cause mortality increased progressively from 8.8% in the lowest exposure quartile to 24.6% in the highest. Nationwide, an estimated 68,440 premature deaths, representing 14.2% of all natural-cause deaths among adults aged ≥30 years, were attributable to PM2.5 exposure. These findings quantify a steep, spatially graded PM2.5-attributable mortality burden across Türkiye. As the attributable estimates derive from the WHO AirQ+ concentration–response function, the gradient describes the magnitude and spatial distribution of the modelled burden rather than an independently estimated exposure–response relationship, and on that basis the results support the adoption of WHO-aligned air-quality standards and accelerated decarbonization strategies to reduce the national health burden attributable to ambient air pollution.
Background/Objectives: Stroke remains a leading cause of death and disability globally, with considerable regional heterogeneity in incidence and mortality reflecting differences in classical vascular risk factors and environmental determinants. Fine particulate matter (PM2.5) is an established modifiable environmental risk factor, yet its association with regional stroke disparities remains understudied in Mediterranean European contexts. We examined regional differences in stroke hospitalization and mortality and their ecological associations with long-term air-pollution exposure across Spain’s 17 autonomous communities from 2013 to 2021. Methods: We conducted a nationwide longitudinal ecological study using aggregated stroke indicators from INCLASNS and ambient air-pollution data from MITECO. The dataset comprised 306 sex-specific region-year observations. The primary outcome was the age-standardized hospitalization rate (ASHR); secondary outcomes were CHR, CMR, ASMR, CFR, and IMI. Associations were assessed using correlation analyses, temporal trends, regional comparisons, and multivariable regression. Sex-stratified analyses were considered exploratory because pollutant concentrations were measured at the regional-year level and were not sex-specific. Results: Mean ASHR was 20.1 ± 5.4 per 10,000 population, with marked regional variation. PM2.5 showed the largest positive ecological correlation with ASMR among all pollutants examined (r = 0.264, p < 0.001), although the correlation remained weak. Overall pollutant–outcome correlations were weak and heterogeneous in direction. Regional variation in stroke burden was not adequately explained by the available air-pollution indicators. Conclusions: PM2.5 was weakly associated with ASMR, whereas associations with hospitalization and other pollutants were small and inconsistent. These ecological findings do not support causal or individual-level inference and warrant confirmation using higher-resolution exposure and individual-level data.
J. Ramírez-Moreno, Víctor Martín Hernández, Andrea Parejo Olivera et al.· Medical Science· 0 citations
Ambient air pollution, particularly fine particulate matter (PM
2.5
), has been linked to cerebrovascular disease. However, findings on the short-term effects of PM
2.5
exposure on hemorrhagic stroke (HS) have been inconsistent across studies. Therefore, this study investigated the association between short-term PM
2.5
exposure and HS hospitalization in Yancheng, China.
An individual-level time-stratified case-crossover study was conducted using hospitalization records of patients with HS from four major hospitals in Yancheng between 2022 and 2024. Conditional logistic regression models were applied to estimate the associations between short-term PM
2.5
exposure and HS hospitalization across different lag structures. Stratified analyses were further performed according to sex, age, hypertension, diabetes, smoking, alcohol consumption, and season.
A total of 2,312 patients hospitalized for HS were included in the analysis. The strongest association was observed at lag01, where each 10 μg/m
3
increase in PM
2.5
concentration was associated with a 3.24% increase in HS hospitalization (95% CI: 0.55%−6.00%). Significant increases were also observed at lag0 and lag1, with corresponding effect estimates of 2.50% (95% CI: 0.11%−4.95%) and 2.76% (95% CI: 0.32%−5.27%), respectively. The associations remained significant after adjustment for ozone (O
3
) but were no longer statistically significant after adjustment for sulfur dioxide (SO
2
), nitrogen dioxide (NO
2
), and carbon monoxide (CO). Relatively stronger effect estimates were observed among females, older adults, individuals with hypertension or diabetes, smokers, alcohol consumers, and during the cold season.
Short-term PM
2.5
exposure was associated with an increased risk of HS hospitalization in Yancheng, China, with the strongest effects observed within the first two days after exposure. The associations were more pronounced among susceptible populations and during the cold season.
K. Qian, Xiao-Rong Xu, Chunxiang Xu et al.· Frontiers in Public Health· 0 citations
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