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This revised version is suitable for publication in PeerJ.
Authors addressed all of my comments.
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Thank you for considering the suggestions.
**PeerJ Staff Note:** Please ensure that all review and editorial comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
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The authors have diligently revised the manuscript according to my suggestions. The study has been conducted properly, the novelty has been clearly highlighted, and both the discussion and the introduction have been significantly improved. My only comment is that, in my opinion, the manuscript is written in average English and requires language improvement before final acceptance. Apart from that, I have no further comments.
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I can still hardly find any information on the clinical implications of this study, thus I believe that the changes in discussion were mainly prompted by Reviewer's 1 comments.
I maintain the opinion that main findings of this paper of the paper are lost within the overall section due to no clear statements or emphases which makes it hard to distinguish any significant novelty.
Please pay particular attention to the detailed feedback from Reviewer 1.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
1) In my opinion title could be improved, exchanging death for mortality and stating nature of the study, for example: Effect of short-term exposure to air pollution on ischemic stroke incidence and mortality: A retrospective time-series study in Jining, China.
2) Please keep in mind that abstract is often first and last part of the article that potential reader might see. At this point, it does not encourage further reading of the manuscript. According to journal guidelines you have up to 500 words, please use them. First of all, present basic characteristic of the study population. Second, make results more readable and expand them. Third, it seems that Results were mixed with Conclusions, please correct this.
3) Lines 42-50 – since you are reporting on ischemic stroke, please present epidemiology of this specific type of stroke and use the most recent statistics.
4) Line 160 – please use “ischemic stroke” rather than “stroke”. Correct in other places.
5) Lines 160-163 – I would suggest using percentage share rather than absolute numbers.
6) What is the difference between lag3-5 (Line 174) and lag 02-06 or lag 03-06? If there is no difference, please unify.
7) Although language is mostly fine, it could benefit from careful revision.
8) The quality of the figures is very low, and they are unreadable, which needs to be improved. Furthermore, consider placing the numerical results in the supplement in the form of tables.
1) Lines 67-71 – explain how disease surveillance systems are more accurate than hospitalization datasets. What is the source of data in these systems? What is the advantage?
2) Please state clearly primary and secondary objectives at the end of introduction.
3) Lines 104-105 - How many air quality monitoring station were taken under consideration? Please state that clearly in the manuscript? Did you have the information on place of residence of patients? If so, did you tie it to the nearest air quality monitoring station?
4) Lines 105-106 – In my opinion, besides mean temperature, you should also include mean humidity and atmospheric pressure, which both can influence the effects of air pollution.
5) Statistical analysis is clearly described and sound. However, what was your thought process behind dividing study population into younger and older than 75 years old (Line 140)? From my experience studies of this type use 65 years old as a benchmark for such division. It could make it harder to extrapolate your results. Please explain.
6) Did you consider including patients’ socioeconomic status as a one of modifying variable?
1) Lines 86-88 – could you provide trends of air pollutants concentration throughout analyzed time?
2) Lines 101-104 – why did you not include ozone? I was under the impression that ozone has become problematic air pollutant in recent years in China.
3) I would like to commend authors for detailed description of study results, however lease make them more concise and present the most important results of your study, less important could be moved to the supplementary materials with appropriate reference.
1) Discussion needs improvement. Please discuss in more rigorous manner the most recent studies on CVD-related to air pollution. Do not focus that much on pathophysiology behind the process. Moreover, it seems one-sided, as most of the studies originate from Asia, please consider including European studies and discuss potential differences.
2) Please discuss conflicting results regarding sensitivity to the harmful effects of air pollution concerning age groups, using recent studies: 10.1093/eurjpc/zwae301 and 10.1161/STROKEAHA.115.010992
3) Line 410 – I think that you should name >75 yo elderly and <75 yo non elderly, it is just suggestion, potentially it could simplify things.
The article is properly written and structured.
This paper has appropriate experimental design, well-described.
This paper supports the thesis on detrimental impact of air pollution on human health.
Thank you for opportunity to review this paper. I congratulate authors on their work. The paper is well-written and conducted properly.
Although the paper investigates important topic for public health, I cannot find significant novelty in this work. Negative impact of air pollution on human health, especially cardiovascular diseases, was thoroughly studied in last years. This paper certainly is valuable, but authors need to go beyond the obscure discussion regarding more co-morbidities in elderly and "more opportunities for outdoor activities than younger people" which is debatable especially in population >75 years old.
Please try to discuss differences in influence of air pollutants, dissimilarities between smog composition and origin in China and other places in world. What is different or new in this paper when compared to others? What are clinical consequences of this study?
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