ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1652872
This article is part of the Research TopicClimate Change, Air Pollution, and Health Inequality: Vulnerability of Marginalized PopulationsView all 24 articles
Global burden of subarachnoid hemorrhage attributable to Ambient PM2.5 in low-resource regions (1990-2050)
Provisionally accepted
Dangmurenjiafu Geng1*
Erman Wu1,2
Tong Tang2
Riqing Su1
Yandong Li1
Maimaitili Mijiti1Gaocai Zhang1Minghao Lian1Yongtao Zhang1
Chang Du3Guohua Zhu1- 1The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- 2Universidade da Coruna, A Coruña, Spain
- 3South China Normal University, Guangzhou, China
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Background Subarachnoid hemorrhage (SAH) is increasingly recognized as a PM2.5-linked neurological emergency, yet global spatiotemporal burden evidence across socioeconomic, demographic, and geographic subgroups remains scarce, impeding targeted prevention. This study quantifies current burden, trends, and future SAH projections attributable to PM2.5 using the latest data. Methods Using data from the Global Burden of Disease Study 2021, we analyzed deaths and disability-adjusted life years (DALYs) from SAH attributable to ambient PM2.5 pollution (1990-2021) across 204 countries/territories, stratified by age, sex, region, and Socio-demographic Index (SDI). Temporal trends were quantified using estimated annual percentage changes (EAPCs), and Bayesian age-period-cohort modeling projected disease burden through 2050. Results Between 1990 and 2021, global age-standardized mortality (ASMR) and DALY rates (ASDR) for PM2.5-related SAH declined by 36% (0.99 to 0.63 per 100,000) and 34% (27.42 to 17.96 per 100,000), respectively. However, absolute deaths surged 40% (38,130 to 53,562), driven by aging populations and demographic shifts. Burden disparities were stark: Middle SDI regions had the highest ASMR (1.07, 95% UI :0.68-1.43) and ASDR (27.42, 95% UI:17.96-35.65), while high SDI regions achieved the steepest declines (−67% ASMR). South Asia (+246% deaths) and Southeast Asia (+147% deaths) experienced the most rapid mortality growth, contrasting with East Asia's high absolute burden (229,553 deaths in 2021). Males faced higher risks (ASMR: 0.72, 95% UI: 0.48 - 0.99) compared with females (0.55, 95% UI: 0.36 - 0.75). In South Asia, the female mortality share was rising from 31% to 41%. Mongolia had the highest national burden (2.49 [95% UI, 1.23-3.82] and ASDR of 61.92 [95% UI, 30.6-93.24]), while Central Asia and Southern Sub-Saharan Africa exhibited worsening trends. Projections indicate a resurgence in ASMR and ASDR by 2050, disproportionately impacting low-middle SDI regions. Conclusions Despite declining age-standardized rates, a 40% surge in absolute PM2.5-attributable SAH deaths over three decades, due to aging populations and regional inequalities (e.g., South Asia +246% deaths, Middle SDI highest ASMR), demands urgent air-quality and healthcare policies for high-growth Asian & African regions and vulnerable low-middle SDI populations to curb projected 2050 increases.
Keywords: PM2.5, Subarachnoid Hemorrhage, disease burden, estimated annualpercentage changes (EAPCs), Bayesian age-period-cohort modeling
Received: 24 Jun 2025; Accepted: 03 Sep 2025.
Copyright: © 2025 Geng, Wu, Tang, Su, Li, Mijiti, Zhang, Lian, Zhang, Du and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dangmurenjiafu Geng, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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