Short-Term Exposure to Ambient Air Pollution and Epilepsy Mortality: A Population-Based Case-Crossover Study

Introduction: As one of the most prevalent neurological disorders, epilepsy imposes a major health burden. Emerging evidence suggests a possible association between air pollution and epilepsy incidence, but its effect on epilepsy-related deaths remains unknown. Methods: We conducted an individual-level time-stratified case-crossover study in Jiangsu province, China (2015–2022) to explore the associations between short-term exposure to air pollution and epilepsy deaths, focusing on fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀₎, sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). Exposure at each subject’s residential address was assessed by extracting concentrations from ChinaHighAirPollutants, a series of validated gridded datasets with a high spatial resolution (1 km × 1 km). Conditional logistic regression models were fitted to quantify exposure-response associations. The attributable fraction and attributable number from air pollution were calculated to estimate their disease burden. Results: Each interquartile range (IQR) increase in exposure to PM_2.5 (IQR: 32.6 μg/m3), PM₁₀ (IQR: 51.3 μg/m3), SO₂ (IQR: 8.5 μg/m3), NO₂ (IQR: 20.8 μg/m3), and CO (IQR: 0.3 mg/m3) was significantly associated with a 10.6% (95% CI: 2.9%, 18.9%), 10.5% (2.8%, 18.8%), 9.9% (0.5%, 20.1%), 9.8% (1.2%, 19.2%), and 8.5% (0.5%, 17.1%) higher odds of epilepsy death (all p < 0.05). The association between PM_2.5 exposure and epilepsy deaths was significantly stronger among individuals <50 years. Up to 12.3% of epilepsy deaths were attributable to air pollution. Conclusion: Exposure to ambient air pollution was significantly associated with increased odds of epilepsy death, especially for younger individuals.