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Associations of PM2.5 Exposure and Solid Fuel Use With Incident Stroke: Evidence From a Longitudinal Chinese Cohort

Year: 2026

Type: article

Abstract: 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 (PM 2.5 ) exposure and solid fuel use with incident stroke among Chinese middle-aged and elderly adults. This prospective cohort study used data from the China Health and Retirement Longitudinal Study. One-year pre-baseline county-level PM 2.5 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 PM 2.5 exposure and solid fuel use with incident stroke. The overall trend across combined exposure categories was evaluated using ordinal exposure scores. 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 PM 2.5 exposure was associated with a higher risk of incident stroke (HR = 1.25, 95% CI: 1.04–1.51). The multiplicative interaction of PM 2.5 exposure and solid fuel use was observed ( P for interaction = 0.022). An overall positive trend was observed between the combined exposure to PM 2.5 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. Combined exposure to ambient PM 2.5 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.

Source: Journal of Epidemiology and Global Health

DOI: 10.1007/s44197-026-00623-x