Abstract Body: Background: Stroke is a leading cause of mortality and disability worldwide, with environmental factors such as air pollution increasingly recognized as significant contributors. This study aims to evaluate the burden of stroke attributable to air pollution in India over a 31-year period.

Methods: We conducted a retrospective analysis using burden of disease study 2021 from 1990 to 2021. The study focused on particulate matter (PM2.5 and PM10) as primary pollutants. The population attributable fraction (PAF) of stroke due to air pollution was calculated using risk estimates from contemporary studies, adjusted for demographic changes.

Results: Over the three-decade period, the total recorded deaths attributable to air pollution-induced strokes amounted to 8,533,316, with an average of 7,983 deaths per year. The total Disability-Adjusted Life Years (DALYs) accrued due to strokes were over 204 million, averaging around 205,890 DALYs annually. Additionally, the total Years of Life Lost (YLLs) summed up to about 14,836,982, with a mean annual YLL of 192,675. Maharashtra reported the highest burden with 56,407 deaths, around 654,246 DALYs, and 611,353 YLLs due to stroke, indicating it as the state most affected by air pollution-related stroke incidents. In contrast, Sikkim reported the lowest stroke burden, with the smallest numbers across all measures: 109 deaths, 1,436 DALYs, and 1,250 YLLs. Males experienced a slightly higher stroke burden due to air pollution with 168,709 deaths and about 4,040,735 Years of Life Lost (YLLs). Females had about 148,785 deaths and approximately 3,377,256 YLLs. The 65-69 years age group had the highest number of deaths at 51,944 and over 1.26 million YLLs. This was closely followed by the 70-74 years age group, with about 54,945 deaths and over 1.10 million YLLs.

Conclusion: Our findings underscore the critical need for stringent air quality control measures and public health strategies to mitigate the impact of air pollution on stroke incidence in India. Younger age groups, particularly below 25 years, show significantly lower numbers, indicating that air pollution primarily impacts the elderly in terms of stroke burden. Addressing this environmental risk factor is crucial for reducing the future burden of stroke and improving public health outcomes.