Long-term exposure to air pollution and cerebrovascular disease: findings from Beijing Health Management Cohort study

● This study explored the long-term association by double robust additive models. ● Individual exposure concentrations were assessed by integrating GAM, LUR and BPNN. ● PM_2.5, SO₂ and NO₂ are positively associated with cerebrovascular disease. ● CO could reduce the risk of cerebrovascular disease with the highest robustness. ● The elderly, women and people with normal BMI are at higher risk for air pollution. The relationship between air pollution and cerebrovascular disease has become a popular topic, yet research findings are highly heterogeneous. This study aims to investigate this association based on detailed individual health data and a precise evaluation of their exposure levels. The integrated models of generalized additive model, land use regression model and back propagation neural network were used to evaluate the exposure concentrations. And doubly robust additive model was conducted to explore the association between cerebrovascular disease and air pollution after adjusted for demographic characteristics, physical examination, disease information, geographic and socioeconomic status. A total of 25097 subjects were included in the Beijing Health Management Cohort from 2013 to 2018. With a 1 μg/m³ increase in the concentrations of PM_2.5, SO₂ and NO₂, the incidence risk of cerebrovascular disease increased by 1.02 (95% CI: 1.008–1.034), 1.06 (95% CI: 1.034–1.095) and 1.02 (95% CI: 1.010–1.029) respectively. Whereas CO exposure could decrease the risk, with an odds ratio of 0.38 (95% CI: 0.212–0.626). In the subgroup analysis, individuals under the age of 50 with normal BMI were at higher risk caused by PM_2.5, and SO₂ was considered more hazardous to women. Meanwhile, the protective effect of CO on women and those with normal BMI was stronger. Successful reduction of long-term exposure to PM_2.5, SO₂ and NO₂ would lead to substantial benefits for decrease the risk of cerebrovascular disease especially for the health of the susceptible individuals.