| Summary: | Background: Existing studies have already shown a connection between nitrogen dioxide (NO<sub>2</sub>) exposure and cerebrovascular mortality. However, the differential effects of NO<sub>2</sub> on cerebrovascular disease and its subtypes remain unclear and require further exploration. Methods: Daily stroke mortality data between 2013 and 2021 in Shanghai, China were collected. Residential daily air pollution data for each decedent were predicted from a satellite model. An individual-level, time-stratified, case-crossover design was applied to examine the relationship between NO<sub>2</sub> exposure and cerebrovascular mortality. A combination of conditional logistic regression and distributed lag models with a maximum lag of 7 days was used for data analysis. Results: A total of 219,147 cases of cerebrovascular mortality were recorded. Among them, the proportion of sequelae of cerebrovascular disease, hemorrhagic stroke and ischemic stroke was 50.7%, 17.1% and 27.5%, respectively. The monotonic increases in mortality risks of cerebrovascular diseases, sequelae of cerebrovascular disease and ischemic stroke were observed, without any discernible thresholds. Each 10 μg/m<sup>3</sup> increase in NO<sub>2</sub> concentration was associated with increments of 3.62% [95% confidence interval (CI): 2.56%, 4.69%] for total cerebrovascular mortality, 4.29% (95% CI: 2.81%, 5.80%) for sequelae of cerebrovascular disease mortality and 4.30% (95% CI: 2.30%, 6.33%) for ischemic stroke mortality. No positive associations between NO<sub>2</sub> exposure and hemorrhagic stroke mortality were observed. A greater risk of NO<sub>2</sub> was observed in the warm season, in patients with less than 9 years of education and in those with single marital status. The effects of NO<sub>2</sub> were robust to mutual adjustment of co-pollutants. Conclusions: Short-term exposures to NO<sub>2</sub> may increase the risk of cerebrovascular mortality, specifically for ischemic stroke and sequelae of cerebrovascular disease.
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