Associations of PM2.5 Exposure and Solid Fuel Use With Incident Stroke: Evidence From a Longitudinal Chinese Cohort
5 affiliations
- 1Department of Clinical Pharmacy, Clinical Pharmacy, Henan Province Key Subjects of Medicine, the First Affiliated Hospital of Henan Medical University, Xinxiang, 453100 P.R. China
- 2The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Pharmaceutical Co., Ltd, Nanjing, 210042 P.R. China
- 3School of Pharmaceutical Sciences, Tsinghua Medicine, Tsinghua University, Beijing, 100084 P.R. China
- 4Neurology Department, the First Affiliated Hospital of Henan Medical University, Xinxiang, 453100 P.R. China
- 5The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing, 210042 P.R. China
Abstract
Background: Outdoor and indoor air pollution often co-occur and may exert combined health effects, but their combined effect on incident stroke risk remains poorly understood. This study aimed to investigate the associations of ambient particulate matter (PM2.5) exposure and solid fuel use with incident stroke among Chinese middle-aged and elderly adults.
Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study. One-year pre-baseline county-level PM2.5 exposure was assigned using the China High Air Pollutants dataset, and household solid fuel use was assessed at baseline according to participants’ primary cooking and heating fuels. Cox proportional hazards models adjusted for prespecified covariates were used to estimate the independent and joint associations of PM2.5 exposure and solid fuel use with incident stroke. The overall trend across combined exposure categories was evaluated using ordinal exposure scores.
Results: Of 13,917 adults with a mean age of 58.90 years, 1,060 developed incident stroke during follow-up. Solid fuel users had a higher risk of incident stroke than nonusers [hazard ratio (HR) = 1.38, 95% confidence interval (CI): 1.18–1.62]. High PM2.5 exposure was associated with a higher risk of incident stroke (HR = 1.25, 95% CI: 1.04–1.51). The multiplicative interaction of PM2.5 exposure and solid fuel use was observed (P for interaction = 0.022). An overall positive trend was observed between the combined exposure to PM2.5 and solid fuel use and incident stroke (HR = 1.10, 95% CI: 1.05–1.15, P for trend < 0.001). Exploratory subgroup analyses showed generally consistent patterns across sex, residence, and comorbidity status.
Conclusion: Combined exposure to ambient PM2.5 and household solid fuel use was associated with a higher risk of incident stroke, with a generally increasing pattern across combined exposure categories. These findings suggest that both indoor and outdoor air pollution should be considered in public health strategies for stroke prevention.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s44197-026-00623-x.
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BibTeX
@article{liu2026associations,
title = {{Associations of PM2.5 Exposure and Solid Fuel Use With Incident Stroke: Evidence From a Longitudinal Chinese Cohort}},
author = {Xiaohong Liu and Rui He and Li Liu and Xiaofei Qin and Shuai Zhao and Peng Hu and Qian Li and Ruisheng Zhao and Dongsheng Chen and Hehua Li},
journal = {Journal of Epidemiology and Global Health},
year = {2026},
month = aug,
doi = {10.1007/s44197-026-00623-x},
url = {https://doi.org/10.1007/s44197-026-00623-x},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Associations of PM2.5 Exposure and Solid Fuel Use With Incident Stroke: Evidence From a Longitudinal Chinese Cohort
AU - Xiaohong Liu
AU - Rui He
AU - Li Liu
AU - Xiaofei Qin
AU - Shuai Zhao
AU - Peng Hu
AU - Qian Li
AU - Ruisheng Zhao
AU - Dongsheng Chen
AU - Hehua Li
PY - 2026
DA - 2026/08/11
JO - Journal of Epidemiology and Global Health
DO - 10.1007/s44197-026-00623-x
UR - https://doi.org/10.1007/s44197-026-00623-x
AB - Background: Outdoor and indoor air pollution often co-occur and may exert combined health effects, but their combined effect on incident stroke risk remains poorly understood. This study aimed to investigate the associations of ambient particulate matter (PM2.5) exposure and solid fuel use with incident stroke among Chinese middle-aged and elderly adults. Methods: This prospective cohort study used data from the China Health and Retirement Longitudinal Study. One-year pre-baseline county-level PM2.5 exposure was assigned using the China High Air Pollutants dataset, and household solid fuel use was assessed at baseline according to participants’ primary cooking and heating fuels. Cox proportional hazards models adjusted for prespecified covariates were used to estimate the independent and joint associations of PM2.5 exposure and solid fuel use with incident stroke. The overall trend across combined exposure categories was evaluated using ordinal exposure scores. Results: Of 13,917 adults with a mean age of 58.90 years, 1,060 developed incident stroke during follow-up. Solid fuel users had a higher risk of incident stroke than nonusers [hazard ratio (HR) = 1.38, 95% confidence interval (CI): 1.18–1.62]. High PM2.5 exposure was associated with a higher risk of incident stroke (HR = 1.25, 95% CI: 1.04–1.51). The multiplicative interaction of PM2.5 exposure and solid fuel use was observed (P for interaction = 0.022). An overall positive trend was observed between the combined exposure to PM2.5 and solid fuel use and incident stroke (HR = 1.10, 95% CI: 1.05–1.15, P for trend < 0.001). Exploratory subgroup analyses showed generally consistent patterns across sex, residence, and comorbidity status. Conclusion: Combined exposure to ambient PM2.5 and household solid fuel use was associated with a higher risk of incident stroke, with a generally increasing pattern across combined exposure categories. These findings suggest that both indoor and outdoor air pollution should be considered in public health strategies for stroke prevention. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s44197-026-00623-x.
SN - 2210-6006
SN - 2210-6014
ER -