Trends in Bipolar Affective Disorder-Related Mortality in the United States, 1999-2023: A CDC WONDER Database Analysis

Trends in Bipolar Affective Disorder-Related Mortality in the United States, 1999-2023: A CDC WONDER Database Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends in Bipolar Affective Disorder-Related Mortality in the United States, 1999-2023: A CDC WONDER Database Analysis Sowmya Kolluru, Mustafa Beidas, Olivia Foley, Rajesh Tampi, Abubakar Tauseef This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7658341/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Feb, 2026 Read the published version in International Journal of Bipolar Disorders → Version 1 posted 10 You are reading this latest preprint version Abstract Background Bipolar Affective Disorder (BPAD) is a class of mood disorders that poses a significant diagnostic challenge for clinicians. With its unknown etiology and the increasing disability burden it contributes to, BPAD necessitates further study to improve patient outcomes. Our study aimed to characterize the demographic trends in BPAD-related mortality using the CDC WONDER database. Methods The CDC WONDER database was utilized to collect data on the mortality burden from 1999–2023. Data was stratified by race, sex, age, rural or urban designation, and census region. Data analysis was performed using Joinpoint analysis to help determine trends as well as statistical significance. Results Our study found that the overall mortality rate from BPAD increased throughout the study period and mortality increased with age. Additionally, the study found statistically significant increases in age adjusted mortality rate when analyzed in groups. Not only was mortality rate determined to be higher amongst females than their male counterparts, variation by race also persisted, with mortality being highest among the Non-Hispanic White cohort. Mortality burden varied by region, with higher mortality rates in rural areas than in urban areas and in the Midwest United States, compared to other census regions. Conclusions Our study expands on prior research related to trends in mortality of BPAD and aims to highlight the disproportionate mortality burdens related to BPAD as a potential guide towards future management strategies. Further studies related to how the increased utilization of mental health resources, including telehealth, and focus on earlier treatment initiation can be useful to guide mental health practices in the future. Bipolar disorder Psychiatry Mental Health Demographics CDC WONDER Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Background: Bipolar Affective Disorder (BPAD), also known as Bipolar disorder, is a class of psychiatric disorders characterized by alternating periods of mania or hypomania and depression. 1 As a class, it includes Bipolar I, which requires the presence of at least one manic episode that may coexist with a preceding or subsequent hypomanic or depressive episode, Bipolar II, which is defined by hypomanic and depressive episodes without meeting the criteria of mania, and other bipolar related disorders. 1 BPAD is a clinical challenge, often going undiagnosed or misdiagnosed. 2 Though the etiology of the disorder is largely unknown, understanding the risk factors and presentation of the disorder is vital to early identification and treatment. 3 With a lifetime prevalence of 1% for Bipolar I in the United States (US) and a mean age of onset in the early twenties, better understanding the impact of the disorder is of growing importance. 3 In addition to posing a diagnostic challenge, BPAD is a leading cause of global disability and a major cause of early mortality, stemming from suicides, homicides, accidents, and medical comorbidities. 1 , 4 Many studies outline the association between BPAD and risk of suicide, with premature mortality from suicide being 11 times higher in individuals with BPAD than without. 4 , 5 , 6 Now, there is growing evidence that mortality risk from natural causes is also increased in BPAD, including from metabolic, cardiovascular, and infectious disease. 5 This is attributable not only to increased incidence, but also to delayed diagnosis and treatment, decreased access to quality medical care and screening, and common medication side effects. 5 , 7 , 8 , 9 Key medications for the management of BPAD include mood stabilizers, such as lithium or valproate, or antipsychotics, such as quetiapine and risperidone. 1 Lithium and quetiapine have a notable risk of Type 2 diabetes mellitus compared to the general population. 8 Moreover, patients treated with the antipsychotics, olanzapine and risperidone, had higher all-cause mortality from either natural or unnatural causes than those treated with lithium. 10 It is vital to recognize the tremendous risk BPAD can pose to patients, not just through symptoms of the disorder, but also through the ways in which it is managed. As such, this study aims to characterize the demographic trends in BPAD-mortality using the CDC WONDER database to elucidate disparities in care for patients with the disorder. The goal is to guide future management strategies and to mitigate the disproportionate mortality burdens of the disorder detailed in this report. Methods Data Collection The Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was utilized to collect data on the mortality burden from BPAD in the US between 1999 and 2023. 11 CDC WONDER utilizes the 10th revision of the International Classification of Diseases (ICD-10) codes to categorize different causes of mortality in patients based on their death certificates. 12 This data, which is deidentified and publicly available through this online database, was probed to identify cases in which BPAD was listed as one of the contributory causes of patient mortality using ICD-10 code F31. Through this study’s analysis, data was stratified by sex, race, age, rural or urban designation, and census region. Sex categories included were male and female and race was grouped into non-Hispanic (NH) White, NH Black, and Hispanic or Latino. Seven different 10-year age cohorts were analyzed, including 25–34 years, 35–44 years, 45–54 years, 55–64 years, 65–74 years, 75–85 years, and over 84 years. Urban and rural designation was made based on the National Center for Health Statistics stratification of US counties into one of six metropolitan or nonmetropolitan cohorts based on population size and level of urbanization. 13 Patients’ legal state of residence at the time of death was utilized to group data into four different census regions, including the Northeast, Midwest, South, and West. 14 Data Analysis Age-adjusted mortality rate (AAMR) was calculated by dividing the number of deaths in each age group by the number of individuals in that age group for each of the different demographic variables outlined above. Joinpoint analysis is a statistical software used to model trends in data, helping to determine their statistical significance. 15 , 16 This modeling strategy is helpful to identify specific years in which significant changes to the data trends occurred, and these specific points are called joinpoints. Each interval between these joinpoints can be mapped with individual regression lines. 17 Using Joinpoint analysis, annual percentage change (APC) and average annual percentage change (AAPC) and their 95% confidence intervals (CI) were determined. APC is used to describe the rate at which AAMR changed by year over our study period. AAPC reflects the average rate of change in AAMR over the course of the study. This data was analyzed and has been compiled and included below. Results Overall: From 1999 to 2023, there were 67,098 deaths due to BPAD in the US (Table 1). Overall, the AAMR increased from 0.4 (95% CI 0.37 to 0.43) in 1999 to 1.73 in 2023, with a peak AAMR of 1.84 in 2022. The average annual percentage change (AAPC) during the study period was 6.19* (95% CI 5.50 to 7.63). The annual percentage change (APC) in AAMR was 24.87* (95% CI 12.59 to 46.75) between 1999 and 2002, which decreased to 3.76* (95% CI 3.19 to 4.30) from 2002 to 2023. Overall, AAMR was lowest in 1999, and generally continued to increase throughout the time of the study. [Insert Table 1] Sex: From 1999 to 2023, BPAD resulted in 38,471 deaths among females and 28,627 deaths in males. The AAMR increased in females from 0.42 in 1999 to 1.78 (95% CI 1.71 to 1.85) in 2023, with a peak AAMR of 1.90 (95% CI 1.83 to 1.98) in 2020. The AAPC in females from 1999 to 2023 was 6.34* (95% CI 5.28 to 7.82). The APC in AAMR was 38.67* (95% CI 11.50 to 63.47) between 1999 and 2001, which decreased to 3.81* (95% CI 3.23 to 4.33) from 2001 to 2023. In females, the overall AAMR was lowest in 1999 and continued to gradually increase throughout the time of the study. In males, the AAMR increased from 0.38 (95% CI in 0.33 to 0.42) in 1999 to 1.64 (95% CI 1.57 to 1.72) in 2023, with a peak AAMR of 1.78 (95% CI 1.71 to 1.86) in 2022. The AAPC in males from 1999 to 2023 was 6.20 (95% CI 5.49 to 7.55). The APC in AAMR was 26.31* (95% CI 16.44 to 45.78) from 1999 to 2002, which decreased to 3.17* (95% CI 0.95 to 4.97) from 2002 to 2018. The APC in AAMR rose again to 10.06 (95% CI -0.82 to 12.75) from 2018 to 2021, prior to decreasing to -2.12 (95% CI -8.78 to 6.69) between 2021 and 2023. In males, the overall AAMR was lowest in 1999 and generally continued to increase throughout the time of the study (Table 1). [Insert Figure 1] [Insert Figure 2] Race: Non-Hispanic White people had the highest AAMR throughout the study period, increasing from 0.47 (95% CI 0.44 to 0.51) in 1999 to 2.03 (95% CI 1.96 to 2.10) in 2023, with a peak AAMR of 2.21 (95% CI 2.14 to 2.29) in 2022 (Table 2). The AAPC during this time period was 5.78* (95% CI 4.97 to 7.23). The APC was 16.42* (95% CI 7.79 to 35.21) between 1999 and 2003, which reduced to 3.77* (95% CI 3.09 to 4.36) from 2003 to 2023. The NH Black population had the second greatest increase in AAMR throughout the study period, starting at an AAMR of 0.19 (95% CI 0.13 to 0.28) in 1999 to 1.50 (95% CI 1.35 to 1.64) in 2023, with a peak AAMR of 1.6 (95% CI 1.45 to 1.75) in 2020 (Table 2). The AAPC during this time period was 8.87* (95% CI 7.96 to 10.45). The APC was 31.28* (95% CI 15.94 to 67.72) from 1999 to 2002, which fell to 5.01* (95% CI 3.45 to 5.90) between the years 2002 and 2017. Subsequently, the APC increased to 18.59* (95% CI 12.14 to 22.30) from 2017 to 2020, before decreasing to -0.75 (95% CI -6.42 to 2.76) from 2020 to 2023. Mortality data for the Hispanic and Latino population was reported from 2000 onwards, due to lack of significant sample size and unreliable data from 1999. The Hispanic and Latino population experienced the smallest increase in AAMR throughout the study, starting at 0.22 (95% CI 0.13 to 0.34) in 2000 and increasing to 0.86 (95% CI 0.75 to 0.96) in 2023, with a peak AAMR of 0.88 (95% CI 0.77 to 0.99) in 2020. The AAPC from 2000 to 2023 was 6.54* (95% CI 5.68 to 7.88) (Table 2). [Insert Table 2] [Insert Figure 3] [Insert Figure 4] Age: Throughout the study period, BPAD-related mortality increased with older age. Individuals over the age of 85 had the highest crude mortality rate (CMR) among all of the ten-year age cohorts, with a crude mortality rate of 2.82 (95% CI 2.31 to 3.33) in 1999, increasing to 6.39 (95% CI 5.76 to 7.02) in 2023. Peak crude mortality rate for this age group was 7.15 (95% CI 6.47 to 7.82) in 2021. During this time, the AAPC was 3.49* (95% CI 2.13 to 5.36). Joinpoint analysis reflected that the APC decreased from 13.50* (95% CI 3.18 to 46.71) between 1999 to 2003 to 1.59 (95% CI -0.38 to 2.35) between 2003 to 2023. For individuals between the ages of 75 to 84, the CMR went from 1.73 (95% CI 1.49 to 1.96) in 1999 to 5.05 (95% CI 4.72 to 5.37) in 2023, reaching its highest value of 5.17 (95% CI 4.83 to 5.51) in 2022. The AAPC for this cohort during the study period was 4.09* (95% CI 3.56 to 4.66). Moreover, the APC from 1999 to 2002 was 20.03* (95% CI 12.66 to 32.54), 0.62 (-0.16 to 1.19) from 2002 to 2016, and 9.59* (95% CI 6.71 to 13.69) from 2016 to 2020. Crude mortality then fell significantly, with an APC of -1.28 (-6.17 to 1.69) from 2020 to 2023. Next, individuals aged 65 to 74 had a CMR of 0.93 (95% CI 0.79 to 1.07) in 1999, which increased to 3.73 (95% CI 3.53 to 3.93) in 2023. The AAPC from 1999 to 2023 was calculated to be 5.83* (95% CI 4.89 to 7.08). From 1999 to 2001, APC was 24.52* (95% CI 5.48 to 44.36). This value decreased to 3.27 (95% CI -1.21 to 3.94) between 2001 to 2017 and increased again to 13.61* (95% CI 7.36 to 17.10) between 2017 to 2020. APC between 2020 to 2023 in this age group was 0.79 (95% CI -5.77 to 4.46). The BPAD-related CMR for individuals aged 55 to 64 was 0.41 (95% CI 0.30 to 0.50) in 1999 and 2.53 (95% CI 2.37 to 2.68) in 2023. AAPC during the study period was 7.79* (95% CI 6.80 to 9.35). From 1999 to 2001, APC was 33.26* (95% CI 12.23 to 56.84). This value decreased to 6.32* (95% CI 5.76 to 7.27) between 2001 to 2021, before decreasing further to 0.006 (95% CI -5.27 to 5.90) between 2021 to 2023. Amongst individuals aged 45 to 54, BPAD-related CMR was 0.22 (95% CI 0.17 to 0.27) in 1999, increasing to 1.16 (95% CI 1.05 1.26) in 2023. AAPC was reported as 6.89* (95% CI 6.22 to 7.86). The APC between 1999 and 2007 was 15.73* (95% CI 12.40 to 20.73) and 2.73* (95% CI 1.88 to 3.50) between 2007 and 2023. The CMR in individuals aged 34 to 45 was 0.1 (95% CI 0.07 to 0.13) in 1999 and 0.68 (95% CI 0.60 to 0.75) in 2023. The AAPC for this group was 8.62* (95% CI 7.86 to 9.86) during this time. APC went from 52.34* (95% CI 31.99 to 74.50) between 1999 to 2001 to 12.91* (95% CI 8.50 to 17.00) between 2001 to 2007, 0.29 (95% CI -5.84 to 1.66) between 2007 and 2016, and finally increased to 5.70* (95% CI 3.73 to 12.12) from 2016 to 2023. The youngest cohort studied, aged 25 to 34, had the lowest CMR related to BPAD. Mortality data for this cohort was reported beginning 2000, due to small sample size and lack of statistically significant data in 1999. This cohort had a CMR of 0.1 (95% CI 0.07 to 0.14) in 2000, which increased to 0.38 (95% CI 0.33 to 0.44) in 2023. In this cohort, the AAPC was 6.03* (95% CI 4.19 to 9.21), and APC decreased from 13.29* (95% CI 5.47 to 56.53) between 2000 and 2006 to 3.57 (95% CI -0.14 to 4.68) between 2006 and 2023. CMR by age can be found in Table 3. [Insert Table 3] [Insert Figure 5] [Insert Figure 6] Rural v. Urban When comparing populated regions, BPAD-related AAMR was initially similar between the rural and urban populations. However, the AAMR in rural areas was higher by the end of the study period when compared to urban areas. Rural areas saw an AAMR of 0.47 (95% CI 0.39 to 0.55) in 1999 increase to 2.36 (95% CI 2.20 to 2.52) in 2020, with an AAPC of 7.38* (95% CI 6.26 to 9.32). Urban areas saw the AAMR increase from 0.40 (95% CI 0.36 to 0.43) in 1999 to 1.70 (95% CI 1.65 to 1.76) in 2020, with AAPC of 6.35* (95% CI 5.65 to 7.29). The APC of the urban areas had multiple significant changes throughout the years. The APC was 24.45* (95% CI 11.90 to 37.67) from 1999 to 2001, before decreasing to 6.42* (95% CI 3.73 to 8.61) between 2001 and 2007. The urban APC then decreased between 2007 and 2016 to 2.14 (95% CI -1.31 to 2.90), before increasing again to 7.56* (95 % CI 5.08 to 13.41) between 2016 and 2020. The APC of the rural areas only had one significant change. The rural APC was 27.38* (95% CI 13.09 to 59.73) from 1999 to 2002, before decreasing to 4.36* (95% CI 3.57 to 5.10) from 2002 to 2020 (Table 4). [Insert Table 4] [Insert Figure 7] [Insert Figure 8] Census Throughout the study period, each census region saw an increase in AAMR. The Midwest saw the greatest increase in BPAD-related AAMR between 1999 and 2023, increasing from 0.44 (95% CI 0.37 to 0.50) in 1999 to 1.87 (95% CI 1.75 to 1.98) in 2023. The peak AAMR for the Midwest was 2.08 (95% CI 1.96 to 2.21) in 2020. The APC of the Midwest was 27.93* (95% CI 15.94 to 49.62) from 1999 to 2002 before decreasing to 3.24* (95% CI 2.81 to 3.67) from 2002 to 2023. Overall, the AAPC of the Midwest was 6.05* (95% CI 5.19 to 6.02). The census region with the next greatest increase in BPAD-related AAMR was the West, with an increase in AAMR from 0.51 (95% CI 0.44 to 0.59) in 1999 to 1.96 (95% CI 1.85 to 2.07) in 2023. The peak AAMR for the West was 2.05 (95% CI 1.93 to 2.16). The APC of the West was 18.68* (95% CI 11.22 to 34.09) from 1999 to 2003 before decreasing to 3.33* (95% CI 2.89 to 3.78) from 2003 to 2023. The AAPC of the West was 5.74* (95% CI 5.10 to 6.81). The AAMR for the South was 0.35 (95% CI 0.30 to 0.40) in 1999, which increased to 1.96 (95% CI 1.85 to 2.07) in 2023, with a peak of 2.05 (95% CI 1.93 to 2.16) in 2022. The APC of the South had multiple significant changes throughout the time period of the study. The APC began at 26.74* (95% CI 13.37 to 40.87) from 1999 to 2001 before decreasing to 7.43* (95% CI 4.30 to 9.67) from 2001 to 2008. The APC decreased once more to 1.68 (95% CI -3.91 to 3.12) from 2008 to 2016 before increasing to 9.05* (95% CI 7.08 to 13.94) from 2016 to 2021. Finally, the APC decreased to -1.13 (95% CI -5.64 to 3.72) from 2021 to 2023. The South experienced the highest AAPC of 6.53* (95% CI 5.94 to 7.43) (Table 5). The AAMR for the Northeast was 0.40 (95% CI 0.34 to 0.47) in 1999, which increased to 1.42 (95% CI 1.31 to 1.53) in 2023, with a peak AAMR of 1.70 (95% CI 1.58 to 1.82) in 2020. The AAPC of the Northeast was the lowest at 4.51* (95% CI 3.82 to 5.37), and there was not a significant change in the APC throughout the study period (Table 5). [Insert Table 5] [Insert Figure 9] [Insert Figure 10] Discussion This study sought to utilize the CDC WONDER database in order to characterize the demographic trends in BPAD-related mortality. A key finding of our study was that the AAMR from BPAD was found to be continuously higher in females when compared to males. When looking at how sex may affect bipolar symptoms and comorbidities, studies have shown that the onset of bipolar disorder tends to occur later in women than men. 18 Additionally, women more often have a seasonal pattern of mood disturbance. Women also experience depressive episodes, mixed mania, and rapid cycling more often than men. 18 Comorbidities can differ between men and women, with men more likely to have substance use disorder while women are more likely to have comorbid anxiety, thyroid disease, and migraines. Previous studies have also examined how there may be gender differences in suicide for patients with BPAD. One study found that although there is no significant difference in suicide ideation between gender, males have a higher prevalence of suicide deaths while women have a higher prevalence of suicide attempts. 19 Despite a higher likelihood to commit suicide among male patients, other studies have found that women are more likely to be misdiagnosed with unipolar depression due to major depressive episodes predominating in women. 20 This can lead to delayed proper treatment and potential triggering of a manic or hypomanic episode. Future studies should investigate more specific reasons as to why BPAD may be a more common cause of death among females despite overall higher suicide risk among male patients. AAMR from BPAD was highest in the NH White population. Studies show that this cohort is more likely to be diagnosed with BPAD, whereas individuals of other races are more likely to be misdiagnosed. 21 This can explain why BPAD-associated complications, including mortality in patients with this diagnosis reported in our study, is higher in the NH White group. The second highest AAMR from BPAD reported was in NH Black patients, but this may be due to misdiagnosis, which also may lead to inadequate treatment. 22 A recent study found that Black or African American patients were less likely than their NH White counterparts to be prescribed lithium, lamotrigine, and carbamazepine, key mood stabilizers used in the treatment of BPAD. 21 This can lead to exacerbations of the mania experienced in BPAD, leading to higher mortality overall. 21 Hispanic and Latino patients presented with the third highest mortality rate from BPAD, but they have been found to be less likely to pursue psychiatric care and take their prescribed medications than NH White patients overall. 23 Finally, Asian and Pacific American patients were found to have the lowest overall BPAD-related mortality, which may be influenced by the culture’s historical avoidance of and stigma surrounding mental health diagnoses. 24 Future studies should examine discrepancies in diagnoses and treatment of BPAD among various racial groups to ensure quality of care and more accurate mortality assessments overall. Throughout the study period, mortality from BPAD increased. Patients with BPAD remain at increased risk of premature mortality than the general population, attributable to causes including suicide, homicide, substance abuse, and comorbid medical illnesses. 25 Studies report that more people are being diagnosed with BPAD in recent years than before. With revisions to criteria to expand the collection of symptoms and duration qualifiers for diagnosis, more individuals are being diagnosed with BPAD and associated disorders to avoid missing early detection and inappropriately treating them for major depressive disorder. 26 Moreover, the utilization of mental health resources has generally continued to increase throughout our study period, which could coincide with decreased stigma surrounding mental health condition. 27 Despite this overall decrease in stigma, however, certain mental health conditions still face harsh perceptions, such as increasing public perceptions of likely violence among patients with schizophrenia. 28 Thus, further studies aimed at how the stigma related to BPAD has shifted throughout the years and its effect on utilization of mental health resources could be beneficial. Across all age groups studied, the mortality rate from BPAD increased over time. The 85 + age cohort had the highest CMR, while the 25–34 year age cohort had the lowest average CMR. Our study finding of the average CMR increasing as the age cohort increased contradicts prior studies. A study looking at the standardized mortality ratio (SMR) for patients aged 15–64 with BPAD in between 1965 to 2014 found that the SMR was highest in the 15–29 group and lowest in the 60–64 group. 29 Potential explanations for the differences could be due to the increased utilization of mental health services in more recent years. 27 Additionally, the shift towards early detection and intervention in psychiatry has allowed patients to begin treatment for bipolar disorder earlier. 30 This is important as longer durations of untreated illness is associated with greater morbidity and decreased response to mood stabilizer treatment. 30 Older age bipolar disorder (OABD) is defined as bipolar disorder over the age of 50. Special consideration should be given to treating patients with OABD. This is due to the variability in clinical course that can be present in OABD patients. For example, some patients may have treatment resistance, shorter time between mood episodes, and decreased cognitive functioning. 31 Cognitive dysfunction and physical comorbidities remain prevalent in patients with OABD, indicating the importance of further investigation as to how to best treat this disease. 31 , 32 AAMR from BPAD was also notably higher in rural than urban US. Rural communities face significant barriers to accessing healthcare resources, including mental health services. Studies have shown that patients residing in rural areas generally had decreased utilization of mental health services, increased emergency department admissions, and increased suicide rates. 33 Barriers to accessing psychiatric services, including high cost and lack of mental health resources, in rural underserved communities lead more patients to pursue care in emergency departments. 34 A study of rural and urban patients with private insurance noted that patients in rural areas were less likely to pursue outpatient visits for mental health care and were more likely to rely on primary care providers than specialists when they did seek care. 35 Moreover, stigma around mental health is reportedly higher in rural areas. 36 , 37 This stigma, coupled with decreased access to care, may cause many patients to delay pursuing care for BPAD, leading to exacerbation of symptoms as escalation of suicidal thoughts and rates. Finally, regional BPAD-related mortality findings correlated with the results found when data was stratified by rural vs. urban assignments. AAMR from BPAD was highest in the Midwest. Compared to other parts of the US, the Midwest has a greater proportion of people living in rural areas. 38 As such, increasing mortality from BPAD may be explained by the stigma and lack of access to resources experienced by individuals living in this region. Despite low population density in rural areas, lack of providers, geographic barriers to care, greater access to firearms, and stigma around help-seeking behaviors can complicate BPAD and lead to poorer outcomes, including suicidal thoughts. 39 , 40 The West had the second highest mortality from BPAD, after the Midwest. In contrast to the Midwest, the high population density of the West could offer an explanation for BPAD-associated mortality. Nine of ten states in the US with the highest rates of suicide were located in the West. 39 Despite the social determinants of health influencing mortality from BPAD in the Midwest, higher population sizes in the West could cause increased rates of suicide, including from mental health conditions like BPAD. Furthermore, the Northeast US had the lowest mortality from BPAD across all census regions studied, which may correlate to this region having the highest per capita supply of mental health providers, including psychiatrists, psychologists, and psychiatric nurse practitioners in the US. 40 Future Directions and Limitations Our results highlight the need to address the disproportionate mortality burdens related to BPAD. This study builds upon findings from previous research and can be utilized to guide future public health strategies. Previous research has noted how stigma can play a role in delayed diagnosis and utilization of mental health resources; thus, public health initiatives aimed at continuing to destigmatize mental health are critical. Additionally, the expansion of telehealth can serve as a valuable resource to increase access to mental health services in areas who lack access to such resources. This study is not without limitations. Firstly, the data analyzed in this study is limited to the information and classification available in the CDC WONDER database. The CDC WONDER database, which uses death certificate information to classify cause of death, may leave room for interpretation by the provider filing the certificate. 41 The use of this study’s target ICD-10 code, F31, solely includes cases where mortality was associated with BPAD, as listed on these certificates. Moreover, no information is provided on specific underlying or contributory causes of mortality in these patients beyond the association with BPAD, be it cardiovascular, cerebrovascular disease, suicide, or other. Further study is required to elucidate the mechanisms of mortality in this cohort. At last, our query, due to data availability, is unable to assess BPAD-associated mortality by urbanization status beyond 2020. Conclusions This study expands on prior research related to trends in mortality of BPAD. Our study aims to highlight the disproportionate mortality burdens related to BPAD as a potential guide towards future management strategies. Researchers report multiple disparities in mortality rates, particularly in the older-age, rural, and NH white populations. Future studies exploring potential causes for these disparities, such as limited access to resources or stigma within communities, can be beneficial. Additionally, further studies examining the increased utilization of mental health resources, including telehealth, and a focus on earlier treatment initiation can be useful to guide mental health practices in the future. Abbreviations BPAD: Bipolar Affective Disorder CDC WONDER: Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research US: United States ICD-10: International Classification of Diseases NH: Non-Hispanic AAMR: Age-adjusted mortality rate APC: Annual percentage change AAPC: Average annual percentage change CI: Confidence Interval CMR: Crude mortality rate SMR: Standardized mortality rate OABD: Older age bipolar disorder Declarations Ethics Approval and Consent to Participate: Not applicable Consent for Publication: Not applicable Availability of Data and Material: All the data generated and analyzed for this study are included in this published article or its supplementary information files. Competing Interests: The authors declare they have no competing interests. Funding: The authors received no funding for the research, authorship, and publication of this article. Authors’ contributions: SK and MB collected, analyzed, and interpreted all of the data. SK and MB were major contributors to the writing of the manuscript. OF led data analysis and contributed to the writing of the manuscript. AT supervised data analysis. AT and RT provided feedback and revisions for the manuscript. All authors read and approved the final manuscript. Acknowledgements: Not applicable References Jain A, Mitra P. Bipolar Disorder. 2023 February 20. Goes FS. Diagnosis and management of bipolar disorders. BMJ. 2023;381:e073591. Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology. 2018;8(9):251–269. Hayes JF, Miles J, Walters K, King M, Osborn DPJ. 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Geographic Variation in the Supply of Selected Behavioral Health Providers. American Journal of Preventive Medicine. 2018;54(6):S199–S207. Iftikhar A, Alam FN, Ashraf DA, Qureshi SH, Akhtar M, Khan AI, et al. Where Do Patients With Cirrhosis Die? A CDC WONDER Analysis From 1999 to 2020. JGH Open. 2025;9(7):e70205–n/a. Tables Table 1: Joinpoint model for BPAD Mortality Rates by Sex. *Indicates significant APC values. Age-Adjusted Mortality Rate (per 100,000) Year Overall Female Male 1999 0.40 0.42 0.38 2000 0.60 0.61 0.55 2001 0.69 0.76 0.60 2002 0.77 0.78 0.77 2003 0.82 0.85 0.80 2004 0.89 0.90 0.87 2005 0.96 0.99 0.84 2006 0.97 1.05 0.85 2007 1.04 1.12 0.95 2008 1.09 1.13 1.05 2009 1.09 1.14 1.02 2010 1.12 1.18 1.05 2011 1.17 1.23 1.07 2012 1.20 1.30 1.09 2013 1.17 1.25 1.10 2014 1.20 1.28 1.12 2015 1.31 1.36 1.16 2016 1.30 1.36 1.19 2017 1.42 1.48 1.31 2018 1.44 1.51 1.32 2019 1.47 1.48 1.41 2020 1.81 1.90 1.68 2021 1.78 1.86 1.66 2022 1.84 1.89 1.78 2023 1.73 1.78 1.64 Number of Joinpoints (Years of Joinpoint) 1 (2002) 1 (2001) 3 (2002, 2018, 2021) APC Segment-1 (95% CI) 24.87* (12.59 to 46.75) 38.67* (11.50-63.47) 26.31* (16.44-45.78) APC Segment-2 (95% CI) 3.7619* (3.19-4.30) 3.81* (3.23 to 4.33) 3.17* (0.95-4.97) APC Segment-3 (95% CI) -- -- 10.06 (-0.82-12.75) APC Segment-4 (95% CI) -- -- -2.12 (-8.78-6.69) Average APC (AAPC) (95% CI) 6.19* (5.50-7.63) 6.34* (5.28-7.82) 6.20* (5.49-7.54) Table 2: Joinpoint model for BPAD Mortality Rates by Race. *Indicates significant APC values. Age-Adjusted Mortality Rate (per 100,000) Year Black or African American White Hispanic or Latino 1999 0.19 0.47 Unreliable 2000 0.27 0.69 0.22 2001 0.32 0.79 Unreliable 2002 0.43 0.88 0.29 2003 0.41 0.98 0.19 2004 0.50 1.01 0.35 2005 0.48 1.12 0.28 2006 0.57 1.12 0.31 2007 0.62 1.23 0.39 2008 0.65 1.29 0.27 2009 0.55 1.36 0.32 2010 0.66 1.34 0.26 2011 0.70 1.40 0.40 2012 0.69 1.44 0.37 2013 0.75 1.42 0.54 2014 0.75 1.46 0.48 2015 0.89 1.53 0.52 2016 0.85 1.55 0.58 2017 0.95 1.69 0.61 2018 1.07 1.73 0.59 2019 1.14 1.73 0.64 2020 1.60 2.11 0.88 2021 1.55 2.14 0.80 2022 1.47 2.21 0.79 2023 1.50 2.03 0.86 Number of Joinpoints (Years of Joinpoint) 3 (2002, 2017, 2020) 1 (2003) 0 APC Segment-1 (95% CI) 31.28* (15.94-67.72) 16.42* (7.79-35.21) 6.54* (5.68-7.88) APC Segment-2 (95% CI) 5.01* (3.45-5.90) 3.77* (3.09-4.36) -- APC Segment-3 (95% CI) 18.59* (12.14-22.30) -- -- APC Segment-4 (95% CI) -0.75 (-6.42-2.76) -- -- Average APC (AAPC) (95% CI) 8.87* (7.96-10.45) 5.78* (4.97-7.23) 6.54* (5.68-7.88) Table 3: Joinpoint model for BPAD Mortality Rates by Age. *Indicates significant APC values. Crude Mortality Rate (per 100,000) Year 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 85+ years 1999 Unreliable 0.10 0.22 0.41 0.93 1.73 2.82 2000 0.10 0.16 0.34 0.59 1.33 2.53 3.54 2001 0.11 0.22 0.37 0.71 1.50 2.81 4.03 2002 0.14 0.26 0.41 0.71 1.73 3.30 3.87 2003 0.11 0.34 0.49 0.87 1.59 3.23 4.86 2004 0.18 0.35 0.59 0.86 1.63 3.36 5.13 2005 0.17 0.37 0.65 0.94 1.73 3.47 5.56 2006 0.26 0.40 0.67 1.04 1.67 3.35 4.85 2007 0.23 0.49 0.82 1.19 1.64 3.44 5.95 2008 0.22 0.48 0.88 1.28 2.00 3.29 5.35 2009 0.25 0.49 0.93 1.23 2.08 3.50 4.96 2010 0.23 0.50 0.92 1.28 1.98 3.55 5.73 2011 0.27 0.49 0.98 1.32 2.12 3.61 5.39 2012 0.25 0.52 1.00 1.52 2.09 3.68 6.18 2013 0.23 0.52 1.04 1.57 2.23 3.50 4.77 2014 0.25 0.51 1.04 1.62 2.38 3.35 5.4 2015 0.25 0.49 1.05 1.85 2.46 3.53 5.55 2016 0.35 0.47 1.08 1.81 2.37 3.82 5.39 2017 0.33 0.58 1.07 2.00 2.69 3.94 6.55 2018 0.30 0.52 1.12 2.01 2.89 4.41 6.11 2019 0.29 0.55 0.99 2.15 2.89 4.44 6.24 2020 0.33 0.60 1.36 2.55 3.88 5.54 7.40 2021 0.42 0.68 1.33 2.57 3.79 4.91 7.15 2022 0.37 0.76 1.42 2.61 3.92 5.17 6.34 2023 0.38 0.68 1.16 2.53 3.73 5.05 6.39 Number of Joinpoints (Years of Joinpoint) 1 (2006) 3 (2001, 2007, 2016) 1 (2007) 2 (2001, 2021) 3 (2001, 2017, 2020) 3 (2002, 2016, 2020) 1 (2003) APC Segment-1 (95% CI) 13.29* (5.47-56.53) 52.34* (31.99-74.50) 15.73* (12.40-20.73) 33.26* (12.23-56.84) 24.52* (5.48-44.36) 20.03* (12.66-32.54) 13.50* (3.18-46.71) APC Segment-2 (95% CI) 3.57 (-0.14-4.68) 12.91* (8.50-17.00) 2.73* (1.88-3.50) 6.32* (5.76-7.27) 3.27 (-1.21-3.94) 0.62 (-0.16-1.19) 1.59 (-0.38-2.35) APC Segment-3 (95% CI) -- 0.29 (-5.84-1.66) -- 0.01 (-5.27-5.90) 13.61* (7.36-17.10) 9.59* (6.71-13.69) -- APC Segment-4 (95% CI) -- 5.70* (3.73-12.12) -- -- 0.79 (-5.77-4.45) -1.28 (-6.17-1.69) -- Average APC (AAPC) (95% CI) 6.03* (4.19-9.21) 8.62* (7.86-9.86) 6.89* (6.22-7.86) 7.79* (6.80-9.35) 5.83* (4.89-7.08) 4.09* (3.56-4.66) 3.49* (2.13-5.36) Table 4: Joinpoint model for BPAD Mortality Rates by Urban or Rural status. *Indicates significant APC values. Age-Adjusted Mortality Rate (per 100,000) Year Urban Rural 1999 0.40 0.47 2000 0.61 0.60 2001 0.66 0.80 2002 0.73 0.91 2003 0.79 1.02 2004 0.84 1.02 2005 0.89 1.1 2006 0.93 1.09 2007 1.03 1.26 2008 1.02 1.35 2009 1.05 1.45 2010 1.07 1.44 2011 1.08 1.47 2012 1.12 1.70 2013 1.14 1.45 2014 1.16 1.55 2015 1.21 1.64 2016 1.22 1.71 2017 1.34 1.81 2018 1.39 1.88 2019 1.38 1.89 2020 1.70 2.36 Number of Joinpoints (Years of Joinpoint) 3 (2001, 2007, 2016) 1 (2002) APC Segment-1 (95% CI) 24.45* (11.90-37.67) 27.38* (13.09-59.73) APC Segment-2 (95% CI) 6.42* (3.73-8.61) 4.36* (3.57-5.10) APC Segment-3 (95% CI) 2.14 (-1.31-2.90) -- APC Segment-4 (95% CI) 7.56* (5.08-13.41) -- Average APC (AAPC) (95% CI) 6.35* (5.65-7.29) 7.38* (6.26-9.32) Table 5: Joinpoint model for BPAD Mortality Rates by Census Region. *Indicates significant APC values. Age-Adjusted Mortality Rate (per 100,000) Year Northeast Midwest South West 1999 0.4 0.44 0.35 0.51 2000 0.61 0.71 0.52 0.68 2001 0.61 0.80 0.61 0.72 2002 0.72 1.02 0.63 0.79 2003 0.66 1.02 0.64 1.05 2004 0.78 1.08 0.72 1.07 2005 0.76 1.17 0.80 1.09 2006 0.70 1.24 0.82 1.15 2007 0.80 1.20 0.98 1.22 2008 0.86 1.32 0.95 1.25 2009 0.80 1.30 1.00 1.34 2010 0.88 1.25 1.03 1.38 2011 0.95 1.40 1.00 1.35 2012 0.94 1.40 1.07 1.51 2013 0.87 1.42 1.05 1.43 2014 0.94 1.43 1.08 1.47 2015 0.99 1.46 1.07 1.63 2016 1.08 1.60 1.15 1.46 2017 1.02 1.71 1.27 1.66 2018 1.21 1.67 1.29 1.65 2019 1.14 1.76 1.33 1.60 2020 1.70 2.08 1.65 1.91 2021 1.52 1.94 1.71 1.99 2022 1.64 1.94 1.73 2.05 2023 1.42 1.87 1.67 1.96 Number of Joinpoints (Years of Joinpoint) 0 1 (2002) 4 (2001, 2008, 2016, 2021) 1 (2003) APC Segment-1 (95% CI) 4.51* (3.82-5.37) 27.93* (15.94-49.62) 26.74* (13.37-40.87) 18.68* (11.22-34.09) APC Segment-2 (95% CI) -- 3.24* (2.81-3.67) 7.43* (4.30-9.67) 3.33* (2.89-3.78) APC Segment-3 (95% CI) -- -- 1.68 (-3.91-3.12) -- APC Segment-4 (95% CI) -- -- 9.05* (7.08-13.94) -- APC Segment-5 (95% CI) -- -- -1.12 (-5.64-3.72) -- Average APC (AAPC) (95% CI) 4.51* (3.82-5.37) 6.05* (5.19-6.92) 6.53* (5.94-7.43) 5.74* (5.10-6.81) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Feb, 2026 Read the published version in International Journal of Bipolar Disorders → Version 1 posted Editorial decision: Revision requested 08 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviews received at journal 25 Sep, 2025 Reviewers agreed at journal 25 Sep, 2025 Reviewers invited by journal 24 Sep, 2025 Editor assigned by journal 23 Sep, 2025 Submission checks completed at journal 23 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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07:19:29","extension":"html","order_by":34,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175560,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/69dc2df4c371729c92485c8f.html"},{"id":93013661,"identity":"a31a40d2-c450-4ee1-8411-5cdd800e6309","added_by":"auto","created_at":"2025-10-08 07:27:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":232314,"visible":true,"origin":"","legend":"\u003cp\u003eBPAD-related Mortality, Stratified by Sex, 1999 to 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e Figure 1 reflects how mortality rate changed overall and among males and females over the study period. Overall, the mortality rate increased over the study period, with the lowest mortality rate in 1999. Mortality rate decreased from 2020 to 2021. It increased slightly from 2021 to 2022, before decreasing in 2023. Similar trends were observed among males and females, with mortality increasing, overall, across the study period. Mortality was consistently higher among females than males throughout the study period.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/3c2c2ad805cbc95cc6d5a61b.jpg"},{"id":93013660,"identity":"d6e40e99-80a8-4b25-90fc-b5bdab86c30d","added_by":"auto","created_at":"2025-10-08 07:27:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74164,"visible":true,"origin":"","legend":"\u003cp\u003eJoinpoint Model of BPAD-related Mortality, Stratified by Sex, 1999 to 2023. *Indicates significant APC values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 2 shows joinpoint models of mortality over the study period, highlighting specific points, or years, during which significant changes to the mortality trend occurred. Individual regression lines between joinpoints are shown. Annual Percent Change (APC) values describing the rate at which mortality rate changed across the study are labeled. “*” Indicates statistically significant APC values. Across all patients, BPAD-related mortality increased from 1999 to 2002, after which time it continued to increase through 2023, though at a slower rate. When stratified by sex, mortality rate amongst females followed a similar trend, increasing at a greater APC from 1999 to 2001 while continuing to increase at a lower APC through the end of the study period. Mortality rates remained lower than females in males, but the data saw increasing variability in APC over the study period.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/76e151b99c847e4df553779e.jpg"},{"id":93011598,"identity":"d8ec8c7a-7dd3-42df-ac4c-c2a419a00d2b","added_by":"auto","created_at":"2025-10-08 07:19:28","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":231854,"visible":true,"origin":"","legend":"\u003cp\u003eBipolar affective disorder-related Mortality Trends, Stratified by Race, 1999 to 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 3 reflects how mortality rate changed by race over the study period. As reflected in the data, mortality rate was consistently highest among the NH White population, followed by the NH Black and Hispanic and Latino populations, respectively. Generally, mortality remained lowest in the Asian and Pacific Islander cohort. Across all race categories analyzed, mortality rate increased in 2023 compared to 1999.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/7ad877bbac2f9f8aa5258a0e.jpg"},{"id":93013662,"identity":"feb67973-a23c-4ab3-bd52-3962991ea25f","added_by":"auto","created_at":"2025-10-08 07:27:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":129112,"visible":true,"origin":"","legend":"\u003cp\u003eJoinpoint Model of BPAD-related Mortality, Stratified by Race, 1999 to 2023. *Indicates significant APC values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 4 shows joinpoint models of mortality over the study period, highlighting specific points, or years, during which significant changes to the mortality trend occurred. Individual regression lines between joinpoints are shown. Annual Percent Change (APC) values describing the rate at which mortality rate changed across the study are labeled. “*” Indicates statistically significant APC values. Mortality rates were consistently higher among the NH White population throughout the study period. APC changed more rapidly at 16.42* from 1999 to 2002, while then consistently increasing at a lower APC of 3.77* through the remainder of the study. Among the NH Black population, mortality rate also increased through the study period until 2020, after which mortality decreased with an APC of -0.75 through 2023. Among the Hispanic and Latino population, mortality increased consistently at an APC of 6.54* from 2000 to 2023.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/31f606a86c79ed977f3cce81.png"},{"id":93011602,"identity":"bde6268e-d4da-4c22-84ee-0a71ceaf2638","added_by":"auto","created_at":"2025-10-08 07:19:28","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":288861,"visible":true,"origin":"","legend":"\u003cp\u003eBipolar affective disorder-related Mortality Trends, Stratified by Age, 1999 to 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 5 reflects how mortality rate changed by age cohort over the study period. As reflected in the data, mortality increased with increasing age. Those over the age of 85 had the highest reported mortality, while those in the 25-34 age group had the lowest overall mortality across the study period.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/ff0430ee93812a9775982c91.jpg"},{"id":93011604,"identity":"cb575858-6d38-49dc-9367-539b5d7e2f5a","added_by":"auto","created_at":"2025-10-08 07:19:28","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":159844,"visible":true,"origin":"","legend":"\u003cp\u003eJoinpoint Model of BPAD-related Mortality, Stratified by Age, 1999 to 2023. *Indicates significant APC values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 6 shows joinpoint models of mortality over the study period, highlighting specific points, or years, during which significant changes to the mortality trend occurred. Individual regression lines between joinpoints are shown. Annual Percent Change (APC) values describing the rate at which mortality rate changed across the study are labeled. “*” Indicates statistically significant APC values. The data reflects increasing BPAD-related mortality with increasing age. In each cohort, variability in APC over the years was noted. In each individual age cohort, mortality rate increased when comparing rates in 1999 and 2023.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/f2dc6ff2aaf71bb4e73a445d.jpg"},{"id":93011605,"identity":"66dee29c-d6cd-466a-9e5c-e3ffb970d967","added_by":"auto","created_at":"2025-10-08 07:19:28","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":151358,"visible":true,"origin":"","legend":"\u003cp\u003eBipolar affective disorder-related Mortality Trends, Stratified by Urbanization, 1999 to 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 7 reflects how mortality rate changed in urban and rural areas. Mortality was initially comparable in urban and rural areas, though slightly higher in the rural communities. By the end of the study period, rural mortality from BPAD was consistently higher than urban areas.\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/ea38670b9d4420eeb8695d44.jpg"},{"id":93013663,"identity":"b83ce9b5-ccdd-4e7d-ab22-f9036a37d50c","added_by":"auto","created_at":"2025-10-08 07:27:28","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":81665,"visible":true,"origin":"","legend":"\u003cp\u003eJoinpoint Model of BPAD-related Mortality, Stratified by Urbanization, 1999 to 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 8 shows joinpoint models of mortality over the study period, highlighting specific points, or years, during which significant changes to the mortality trend occurred. Individual regression lines between joinpoints are shown. Annual Percent Change (APC) values describing the rate at which mortality rate changed across the study are labeled. “*” Indicates statistically significant APC values. Mortality was higher in the rural US compared to urban US throughout the study period. Among both cohorts, mortality increased over the years. In rural areas, from 1999 to 2002, APC was higher than it was from 2002 to 2020. In urban areas, APC demonstrated more variability, though mortality continued to trend upwards.\u003c/p\u003e","description":"","filename":"Figure8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/38b35990ff1e4ecbd43289d0.jpg"},{"id":93013674,"identity":"405c2a03-2585-468c-a29f-7bef770475bb","added_by":"auto","created_at":"2025-10-08 07:27:29","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":253106,"visible":true,"origin":"","legend":"\u003cp\u003eBipolar affective disorder-related Mortality Trends, Stratified by Census Region, 1999 to 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 9 summarizes trends in mortality across the four US Census Regions over the study period. Across all census regions, mortality increased across the study period. The Midwest had the greatest mortality increase, from 0.44 in 1999 to 1.87 in 2023, with a peak in 2020 of 2.08. The West saw the greatest increase in mortality rate, from 0.51 to 1.96 in 2023. Mortality peaked in 2022 at 2.05. The South and Northeast regions also saw an increase in mortality rate across the study period, though less than rates in the South and West.\u003c/p\u003e","description":"","filename":"Figure9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/ee81eb4a02284fc0896e5008.jpg"},{"id":93011613,"identity":"43be3b63-6e8f-4db2-a151-c386782f8243","added_by":"auto","created_at":"2025-10-08 07:19:29","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":105217,"visible":true,"origin":"","legend":"\u003cp\u003eJoinpoint Model of BPAD-related Mortality, Stratified by Region, 1999 to 2023. *Indicates significant APC values.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend: \u003c/strong\u003eFigure 10 shows joinpoint models of mortality over the study period, highlighting specific points, or years, during which significant changes to the mortality trend occurred. Individual regression lines between joinpoints are shown. Annual Percent Change (APC) values describing the rate at which mortality rate changed across the study are labeled. “*” Indicates statistically significant APC values. The Midwest saw the greatest increase in BPAD-related mortality between 1999 and 2023. APC in the Midwest decreased from 27.93* from 1999 to 2022 to 3.24* from 2002 to 2023. The West also saw an increasing mortality rate. APC increased more rapidly with APC of 18.68* from 1999 to 2003 to 3.33* through the remainder of the study period. The South had the lowest initial mortality rate from BPAD reported in 1999. APC demonstrated increasing variability in this region across the study period, increasing by varying rates until 2021, after which mortality decreased at an APC of -1.13 through 2023. The mortality rate was higher than the Northeast by the end of the study period. Consistently, mortality increased at a steady APC in the Northeast between 1999 and 2023.\u003c/p\u003e","description":"","filename":"Figure10.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/e10cb2dcbfc80821ec7e4e87.jpg"},{"id":102234186,"identity":"504da588-6c26-49ca-ab95-42788369af34","added_by":"auto","created_at":"2026-02-09 16:07:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3041379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7658341/v1/6da63efb-c605-4229-9526-5f8b82a84697.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in Bipolar Affective Disorder-Related Mortality in the United States, 1999-2023: A CDC WONDER Database Analysis","fulltext":[{"header":"Background:","content":"\u003cp\u003eBipolar Affective Disorder (BPAD), also known as Bipolar disorder, is a class of psychiatric disorders characterized by alternating periods of mania or hypomania and depression.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e As a class, it includes Bipolar I, which requires the presence of at least one manic episode that may coexist with a preceding or subsequent hypomanic or depressive episode, Bipolar II, which is defined by hypomanic and depressive episodes without meeting the criteria of mania, and other bipolar related disorders.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e BPAD is a clinical challenge, often going undiagnosed or misdiagnosed.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Though the etiology of the disorder is largely unknown, understanding the risk factors and presentation of the disorder is vital to early identification and treatment.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e With a lifetime prevalence of 1% for Bipolar I in the United States (US) and a mean age of onset in the early twenties, better understanding the impact of the disorder is of growing importance.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn addition to posing a diagnostic challenge, BPAD is a leading cause of global disability and a major cause of early mortality, stemming from suicides, homicides, accidents, and medical comorbidities.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Many studies outline the association between BPAD and risk of suicide, with premature mortality from suicide being 11 times higher in individuals with BPAD than without.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Now, there is growing evidence that mortality risk from natural causes is also increased in BPAD, including from metabolic, cardiovascular, and infectious disease.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This is attributable not only to increased incidence, but also to delayed diagnosis and treatment, decreased access to quality medical care and screening, and common medication side effects.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Key medications for the management of BPAD include mood stabilizers, such as lithium or valproate, or antipsychotics, such as quetiapine and risperidone.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Lithium and quetiapine have a notable risk of Type 2 diabetes mellitus compared to the general population.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Moreover, patients treated with the antipsychotics, olanzapine and risperidone, had higher all-cause mortality from either natural or unnatural causes than those treated with lithium.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e It is vital to recognize the tremendous risk BPAD can pose to patients, not just through symptoms of the disorder, but also through the ways in which it is managed.\u003c/p\u003e\u003cp\u003eAs such, this study aims to characterize the demographic trends in BPAD-mortality using the CDC WONDER database to elucidate disparities in care for patients with the disorder. The goal is to guide future management strategies and to mitigate the disproportionate mortality burdens of the disorder detailed in this report.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eThe Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was utilized to collect data on the mortality burden from BPAD in the US between 1999 and 2023.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e CDC WONDER utilizes the 10th revision of the International Classification of Diseases (ICD-10) codes to categorize different causes of mortality in patients based on their death certificates.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This data, which is deidentified and publicly available through this online database, was probed to identify cases in which BPAD was listed as one of the contributory causes of patient mortality using ICD-10 code F31.\u003c/p\u003e\u003cp\u003eThrough this study\u0026rsquo;s analysis, data was stratified by sex, race, age, rural or urban designation, and census region. Sex categories included were male and female and race was grouped into non-Hispanic (NH) White, NH Black, and Hispanic or Latino. Seven different 10-year age cohorts were analyzed, including 25\u0026ndash;34 years, 35\u0026ndash;44 years, 45\u0026ndash;54 years, 55\u0026ndash;64 years, 65\u0026ndash;74 years, 75\u0026ndash;85 years, and over 84 years. Urban and rural designation was made based on the National Center for Health Statistics stratification of US counties into one of six metropolitan or nonmetropolitan cohorts based on population size and level of urbanization.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Patients\u0026rsquo; legal state of residence at the time of death was utilized to group data into four different census regions, including the Northeast, Midwest, South, and West.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eAge-adjusted mortality rate (AAMR) was calculated by dividing the number of deaths in each age group by the number of individuals in that age group for each of the different demographic variables outlined above. Joinpoint analysis is a statistical software used to model trends in data, helping to determine their statistical significance.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This modeling strategy is helpful to identify specific years in which significant changes to the data trends occurred, and these specific points are called joinpoints. Each interval between these joinpoints can be mapped with individual regression lines.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Using Joinpoint analysis, annual percentage change (APC) and average annual percentage change (AAPC) and their 95% confidence intervals (CI) were determined. APC is used to describe the rate at which AAMR changed by year over our study period. AAPC reflects the average rate of change in AAMR over the course of the study. This data was analyzed and has been compiled and included below.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eOverall:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1999 to 2023, there were 67,098 deaths due to BPAD in the US (Table 1). \u0026nbsp; Overall, the AAMR increased from 0.4 (95% CI 0.37 to 0.43) in 1999 to 1.73 in 2023, with a peak AAMR of 1.84 in 2022. The average annual percentage change (AAPC) during the study period was 6.19* (95% CI 5.50 to 7.63). The annual percentage change (APC) in AAMR was 24.87* (95% CI 12.59 to 46.75) between 1999 and 2002, which decreased to 3.76* (95% CI 3.19 to 4.30) from 2002 to 2023. Overall, AAMR was lowest in 1999, and generally continued to increase throughout the time of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 1]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSex:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1999 to 2023, BPAD resulted in 38,471 deaths among females and 28,627 deaths in males. \u0026nbsp;The AAMR increased in females from 0.42 in 1999 to 1.78 (95% CI 1.71 to 1.85) in 2023, with a peak AAMR of 1.90 (95% CI 1.83 to 1.98) in 2020. The AAPC in females from 1999 to 2023 was 6.34* (95% CI 5.28 to 7.82). The APC in AAMR was 38.67* (95% CI 11.50 to 63.47) between 1999 and 2001, which decreased to 3.81* (95% CI 3.23 to 4.33) from 2001 to 2023. In females, the overall AAMR was lowest in 1999 and continued to gradually increase throughout the time of the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn males, the AAMR increased from 0.38 (95% CI in 0.33 to 0.42) in 1999 to 1.64 (95% CI 1.57 to 1.72) in 2023, with a peak AAMR of 1.78 (95% CI 1.71 to 1.86) in 2022. \u0026nbsp;The AAPC in males from 1999 to 2023 was 6.20 (95% CI 5.49 to 7.55). The APC in AAMR was 26.31* (95% CI 16.44 to 45.78) from 1999 to 2002, which decreased to 3.17* (95% CI 0.95 to 4.97) from 2002 to 2018. \u0026nbsp;The APC in AAMR rose again to 10.06 (95% CI -0.82 to 12.75) from 2018 to 2021, prior to decreasing to -2.12 (95% CI -8.78 to 6.69) between 2021 and 2023. In males, the overall AAMR was lowest in 1999 and generally continued to increase throughout the time of the study (Table 1).\u003c/p\u003e\n\u003cp\u003e[Insert Figure 1]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 2]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRace:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNon-Hispanic White people had the highest AAMR throughout the study period, increasing from 0.47 (95% CI 0.44 to 0.51) in 1999 to 2.03 (95% CI 1.96 to 2.10) in 2023, with a peak AAMR of 2.21 (95% CI 2.14 to 2.29) in 2022 (Table 2). \u0026nbsp; The AAPC during this time period was 5.78* (95% CI 4.97 to 7.23). The APC was 16.42* (95% CI 7.79 to 35.21) between 1999 and 2003, which reduced to 3.77* (95% CI 3.09 to 4.36) from 2003 to 2023. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe NH Black population had the second greatest increase in AAMR throughout the study period, starting at an AAMR of 0.19 (95% CI 0.13 to 0.28) in 1999 to 1.50 (95% CI 1.35 to 1.64) in 2023, with a peak AAMR of 1.6 (95% CI 1.45 to 1.75) in 2020 (Table 2). The AAPC during this time period was 8.87* (95% CI 7.96 to 10.45). The APC was 31.28* (95% CI 15.94 to 67.72) from 1999 to 2002, which fell to 5.01* (95% CI 3.45 to 5.90) between the years 2002 and 2017. \u0026nbsp; Subsequently, the APC increased to 18.59* (95% CI 12.14 to 22.30) from 2017 to 2020, before decreasing to -0.75 (95% CI -6.42 to 2.76) from 2020 to 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMortality data for the Hispanic and Latino population was reported from 2000 onwards, due to lack of significant sample size and unreliable data from 1999. The Hispanic and Latino population experienced the smallest increase in AAMR throughout the study, starting at 0.22 (95% CI 0.13 to 0.34) in 2000 and increasing to 0.86 (95% CI 0.75 to 0.96) in 2023, with a peak AAMR of 0.88 (95% CI 0.77 to 0.99) in 2020. The AAPC from 2000 to 2023 was 6.54* (95% CI 5.68 to 7.88) (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 2]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Figure 3]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 4]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAge:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThroughout the study period, BPAD-related mortality increased with older age. Individuals over the age of 85 had the highest crude mortality rate (CMR) among all of the ten-year age cohorts, with a crude mortality rate of 2.82 (95% CI 2.31 to 3.33) in 1999, increasing to 6.39 (95% CI 5.76 to 7.02) in 2023. \u0026nbsp;Peak crude mortality rate for this age group was 7.15 (95% CI 6.47 to 7.82) in 2021. During this time, the AAPC was 3.49* (95% CI 2.13 to 5.36). Joinpoint analysis reflected that the APC decreased from 13.50* (95% CI 3.18 to 46.71) between 1999 to 2003 to 1.59 (95% CI -0.38 to 2.35) between 2003 to 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor individuals between the ages of 75 to 84, the CMR went from 1.73 (95% CI 1.49 to 1.96) in 1999 to 5.05 (95% CI 4.72 to 5.37) in 2023, reaching its highest value of 5.17 (95% CI 4.83 to 5.51) in 2022. The AAPC for this cohort during the study period was 4.09* (95% CI 3.56 to 4.66). Moreover, the APC from 1999 to 2002 was 20.03* (95% CI 12.66 to 32.54), 0.62 (-0.16 to 1.19) from 2002 to 2016, and 9.59* (95% CI 6.71 to 13.69) from 2016 to 2020. Crude mortality then fell significantly, with an APC of -1.28 (-6.17 to 1.69) from 2020 to 2023. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNext, individuals aged 65 to 74 had a CMR of 0.93 (95% CI 0.79 to 1.07) in 1999, which increased to 3.73 (95% CI 3.53 to 3.93) in 2023. The AAPC from 1999 to 2023 was calculated to be 5.83* (95% CI 4.89 to 7.08). From 1999 to 2001, APC was 24.52* (95% CI 5.48 to 44.36). This value decreased to 3.27 (95% CI -1.21 to 3.94) between 2001 to 2017 and increased again to 13.61* (95% CI 7.36 to 17.10) between 2017 to 2020. APC between 2020 to 2023 in this age group was 0.79 (95% CI -5.77 to 4.46).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe BPAD-related CMR for individuals aged 55 to 64 was 0.41 (95% CI 0.30 to 0.50) in 1999 and 2.53 (95% CI 2.37 to 2.68) in 2023. AAPC during the study period was 7.79* (95% CI 6.80 to 9.35). From 1999 to 2001, APC was 33.26* (95% CI 12.23 to 56.84). This value decreased to 6.32* (95% CI 5.76 to 7.27) between 2001 to 2021, before decreasing further to 0.006 (95% CI -5.27 to 5.90) between 2021 to 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmongst individuals aged 45 to 54, BPAD-related CMR was 0.22 (95% CI 0.17 to 0.27) in 1999, increasing to 1.16 (95% CI 1.05 1.26) in 2023. AAPC was reported as 6.89* (95% CI 6.22 to 7.86). The APC between 1999 and 2007 was 15.73* (95% CI 12.40 to 20.73) and 2.73* (95% CI 1.88 to 3.50) between 2007 and 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe CMR in individuals aged 34 to 45 was 0.1 (95% CI 0.07 to 0.13) in 1999 and 0.68 (95% CI 0.60 to 0.75) in 2023. The AAPC for this group was 8.62* (95% CI 7.86 to 9.86) during this time. APC went from 52.34* (95% CI 31.99 to 74.50) between 1999 to 2001 to 12.91* (95% CI 8.50 to 17.00) between 2001 to 2007, 0.29 (95% CI -5.84 to 1.66) between 2007 and 2016, and finally increased to 5.70* (95% CI 3.73 to 12.12) from 2016 to 2023.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe youngest cohort studied, aged 25 to 34, had the lowest CMR related to BPAD. Mortality data for this cohort was reported beginning 2000, due to small sample size and lack of statistically significant data in 1999. This cohort had a CMR of 0.1 (95% CI 0.07 to 0.14) in 2000, which increased to 0.38 (95% CI 0.33 to 0.44) in 2023. In this cohort, the AAPC was 6.03* (95% CI 4.19 to 9.21), and APC decreased from 13.29* (95% CI 5.47 to 56.53) between 2000 and 2006 to 3.57 (95% CI -0.14 to 4.68) between 2006 and 2023. CMR by age can be found in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 3]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Figure 5]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 6]\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eRural v. Urban\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen comparing populated regions, BPAD-related AAMR was initially similar between the rural and urban populations. However, the AAMR in rural areas was higher by the end of the study period when compared to urban areas. Rural areas saw an AAMR of 0.47 (95% CI 0.39 to 0.55) in 1999 increase to 2.36 (95% CI 2.20 to 2.52) in 2020, with an AAPC of 7.38* (95% CI 6.26 to 9.32). Urban areas saw the AAMR increase from 0.40 (95% CI 0.36 to 0.43) in 1999 to 1.70 (95% CI 1.65 to 1.76) in 2020, with AAPC of 6.35* (95% CI 5.65 to 7.29). The APC of the urban areas had multiple significant changes throughout the years. The APC was 24.45* (95% CI 11.90 to 37.67) from 1999 to 2001, before decreasing to 6.42* (95% CI 3.73 to 8.61) between 2001 and 2007. The urban APC then decreased between 2007 and 2016 to 2.14 (95% CI -1.31 to 2.90), before increasing again to 7.56* (95 % CI 5.08 to 13.41) between 2016 and 2020. The APC of the rural areas only had one significant change. The rural APC was 27.38* (95% CI 13.09 to 59.73) from 1999 to 2002, before decreasing to 4.36* (95% CI 3.57 to 5.10) from 2002 to 2020 (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 4]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Figure 7]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 8]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCensus\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThroughout the study period, each census region saw an increase in AAMR. The Midwest saw the greatest increase in BPAD-related AAMR between 1999 and 2023, increasing from 0.44 (95% CI 0.37 to 0.50) in 1999 to 1.87 (95% CI 1.75 to 1.98) in 2023. The peak AAMR for the Midwest was 2.08 (95% CI 1.96 to 2.21) in 2020. The APC of the Midwest was 27.93* (95% CI 15.94 to 49.62) from 1999 to 2002 before decreasing to 3.24* (95% CI 2.81 to 3.67) from 2002 to 2023. Overall, the AAPC of the Midwest was 6.05* (95% CI 5.19 to 6.02). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe census region with the next greatest increase in BPAD-related AAMR was the West, with an increase in AAMR from 0.51 (95% CI 0.44 to 0.59) in 1999 to 1.96 (95% CI 1.85 to 2.07) in 2023. The peak AAMR for the West was 2.05 (95% CI 1.93 to 2.16). The APC of the West was 18.68* (95% CI 11.22 to 34.09) from 1999 to 2003 before decreasing to 3.33* (95% CI 2.89 to 3.78) from 2003 to 2023. The AAPC of the West was 5.74* (95% CI 5.10 to 6.81).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe AAMR for the South was 0.35 (95% CI 0.30 to 0.40) in 1999, which increased to 1.96 (95% CI 1.85 to 2.07) in 2023, with a peak of 2.05 (95% CI 1.93 to 2.16) in 2022. The APC of the South had multiple significant changes throughout the time period of the study. The APC began at 26.74* (95% CI 13.37 to 40.87) from 1999 to 2001 before decreasing to 7.43* (95% CI 4.30 to 9.67) from 2001 to 2008. The APC decreased once more to 1.68 (95% CI -3.91 to 3.12) from 2008 to 2016 before increasing to 9.05* (95% CI 7.08 to 13.94) from 2016 to 2021. Finally, the APC decreased to -1.13 (95% CI -5.64 to 3.72) from 2021 to 2023. The South experienced the highest AAPC of 6.53* (95% CI 5.94 to 7.43) (Table 5). \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe AAMR for the Northeast was 0.40 (95% CI 0.34 to 0.47) in 1999, which increased to 1.42 (95% CI 1.31 to 1.53) in 2023, with a peak AAMR of 1.70 (95% CI 1.58 to 1.82) in 2020. The AAPC of the Northeast was the lowest at 4.51* (95% CI 3.82 to 5.37), and there was not a significant change in the APC throughout the study period (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 5] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Figure 9]\u003c/p\u003e\n\u003cp\u003e[Insert Figure 10]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study sought to utilize the CDC WONDER database in order to characterize the demographic trends in BPAD-related mortality. A key finding of our study was that the AAMR from BPAD was found to be continuously higher in females when compared to males. When looking at how sex may affect bipolar symptoms and comorbidities, studies have shown that the onset of bipolar disorder tends to occur later in women than men.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Additionally, women more often have a seasonal pattern of mood disturbance. Women also experience depressive episodes, mixed mania, and rapid cycling more often than men.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Comorbidities can differ between men and women, with men more likely to have substance use disorder while women are more likely to have comorbid anxiety, thyroid disease, and migraines. Previous studies have also examined how there may be gender differences in suicide for patients with BPAD. One study found that although there is no significant difference in suicide ideation between gender, males have a higher prevalence of suicide deaths while women have a higher prevalence of suicide attempts.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Despite a higher likelihood to commit suicide among male patients, other studies have found that women are more likely to be misdiagnosed with unipolar depression due to major depressive episodes predominating in women.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e This can lead to delayed proper treatment and potential triggering of a manic or hypomanic episode. Future studies should investigate more specific reasons as to why BPAD may be a more common cause of death among females despite overall higher suicide risk among male patients.\u003c/p\u003e\u003cp\u003eAAMR from BPAD was highest in the NH White population. Studies show that this cohort is more likely to be diagnosed with BPAD, whereas individuals of other races are more likely to be misdiagnosed.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e This can explain why BPAD-associated complications, including mortality in patients with this diagnosis reported in our study, is higher in the NH White group. The second highest AAMR from BPAD reported was in NH Black patients, but this may be due to misdiagnosis, which also may lead to inadequate treatment.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e A recent study found that Black or African American patients were less likely than their NH White counterparts to be prescribed lithium, lamotrigine, and carbamazepine, key mood stabilizers used in the treatment of BPAD.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e This can lead to exacerbations of the mania experienced in BPAD, leading to higher mortality overall.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Hispanic and Latino patients presented with the third highest mortality rate from BPAD, but they have been found to be less likely to pursue psychiatric care and take their prescribed medications than NH White patients overall.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Finally, Asian and Pacific American patients were found to have the lowest overall BPAD-related mortality, which may be influenced by the culture’s historical avoidance of and stigma surrounding mental health diagnoses.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Future studies should examine discrepancies in diagnoses and treatment of BPAD among various racial groups to ensure quality of care and more accurate mortality assessments overall.\u003c/p\u003e\u003cp\u003eThroughout the study period, mortality from BPAD increased. Patients with BPAD remain at increased risk of premature mortality than the general population, attributable to causes including suicide, homicide, substance abuse, and comorbid medical illnesses.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Studies report that more people are being diagnosed with BPAD in recent years than before. With revisions to criteria to expand the collection of symptoms and duration qualifiers for diagnosis, more individuals are being diagnosed with BPAD and associated disorders to avoid missing early detection and inappropriately treating them for major depressive disorder.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Moreover, the utilization of mental health resources has generally continued to increase throughout our study period, which could coincide with decreased stigma surrounding mental health condition.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Despite this overall decrease in stigma, however, certain mental health conditions still face harsh perceptions, such as increasing public perceptions of likely violence among patients with schizophrenia.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Thus, further studies aimed at how the stigma related to BPAD has shifted throughout the years and its effect on utilization of mental health resources could be beneficial.\u003c/p\u003e\u003cp\u003eAcross all age groups studied, the mortality rate from BPAD increased over time. The 85 + age cohort had the highest CMR, while the 25–34 year age cohort had the lowest average CMR. Our study finding of the average CMR increasing as the age cohort increased contradicts prior studies. A study looking at the standardized mortality ratio (SMR) for patients aged 15–64 with BPAD in between 1965 to 2014 found that the SMR was highest in the 15–29 group and lowest in the 60–64 group.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Potential explanations for the differences could be due to the increased utilization of mental health services in more recent years.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Additionally, the shift towards early detection and intervention in psychiatry has allowed patients to begin treatment for bipolar disorder earlier.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e This is important as longer durations of untreated illness is associated with greater morbidity and decreased response to mood stabilizer treatment.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Older age bipolar disorder (OABD) is defined as bipolar disorder over the age of 50. Special consideration should be given to treating patients with OABD. This is due to the variability in clinical course that can be present in OABD patients. For example, some patients may have treatment resistance, shorter time between mood episodes, and decreased cognitive functioning.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Cognitive dysfunction and physical comorbidities remain prevalent in patients with OABD, indicating the importance of further investigation as to how to best treat this disease.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAAMR from BPAD was also notably higher in rural than urban US. Rural communities face significant barriers to accessing healthcare resources, including mental health services. Studies have shown that patients residing in rural areas generally had decreased utilization of mental health services, increased emergency department admissions, and increased suicide rates.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Barriers to accessing psychiatric services, including high cost and lack of mental health resources, in rural underserved communities lead more patients to pursue care in emergency departments.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e A study of rural and urban patients with private insurance noted that patients in rural areas were less likely to pursue outpatient visits for mental health care and were more likely to rely on primary care providers than specialists when they did seek care.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Moreover, stigma around mental health is reportedly higher in rural areas.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e This stigma, coupled with decreased access to care, may cause many patients to delay pursuing care for BPAD, leading to exacerbation of symptoms as escalation of suicidal thoughts and rates.\u003c/p\u003e\u003cp\u003eFinally, regional BPAD-related mortality findings correlated with the results found when data was stratified by rural vs. urban assignments. AAMR from BPAD was highest in the Midwest. Compared to other parts of the US, the Midwest has a greater proportion of people living in rural areas.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e As such, increasing mortality from BPAD may be explained by the stigma and lack of access to resources experienced by individuals living in this region. Despite low population density in rural areas, lack of providers, geographic barriers to care, greater access to firearms, and stigma around help-seeking behaviors can complicate BPAD and lead to poorer outcomes, including suicidal thoughts.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The West had the second highest mortality from BPAD, after the Midwest. In contrast to the Midwest, the high population density of the West could offer an explanation for BPAD-associated mortality. Nine of ten states in the US with the highest rates of suicide were located in the West.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Despite the social determinants of health influencing mortality from BPAD in the Midwest, higher population sizes in the West could cause increased rates of suicide, including from mental health conditions like BPAD. Furthermore, the Northeast US had the lowest mortality from BPAD across all census regions studied, which may correlate to this region having the highest per capita supply of mental health providers, including psychiatrists, psychologists, and psychiatric nurse practitioners in the US.\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eFuture Directions and Limitations\u003c/p\u003e\u003cp\u003eOur results highlight the need to address the disproportionate mortality burdens related to BPAD. This study builds upon findings from previous research and can be utilized to guide future public health strategies. Previous research has noted how stigma can play a role in delayed diagnosis and utilization of mental health resources; thus, public health initiatives aimed at continuing to destigmatize mental health are critical. Additionally, the expansion of telehealth can serve as a valuable resource to increase access to mental health services in areas who lack access to such resources. This study is not without limitations. Firstly, the data analyzed in this study is limited to the information and classification available in the CDC WONDER database. The CDC WONDER database, which uses death certificate information to classify cause of death, may leave room for interpretation by the provider filing the certificate.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e The use of this study’s target ICD-10 code, F31, solely includes cases where mortality was associated with BPAD, as listed on these certificates. Moreover, no information is provided on specific underlying or contributory causes of mortality in these patients beyond the association with BPAD, be it cardiovascular, cerebrovascular disease, suicide, or other. Further study is required to elucidate the mechanisms of mortality in this cohort. At last, our query, due to data availability, is unable to assess BPAD-associated mortality by urbanization status beyond 2020.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study expands on prior research related to trends in mortality of BPAD. Our study aims to highlight the disproportionate mortality burdens related to BPAD as a potential guide towards future management strategies. Researchers report multiple disparities in mortality rates, particularly in the older-age, rural, and NH white populations. Future studies exploring potential causes for these disparities, such as limited access to resources or stigma within communities, can be beneficial. Additionally, further studies examining the increased utilization of mental health resources, including telehealth, and a focus on earlier treatment initiation can be useful to guide mental health practices in the future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBPAD: Bipolar Affective Disorder\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCDC WONDER: Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUS: United States\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICD-10: International Classification of Diseases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNH: Non-Hispanic\u003c/p\u003e\n\u003cp\u003eAAMR: Age-adjusted mortality rate\u003c/p\u003e\n\u003cp\u003eAPC: Annual percentage change\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAAPC: Average annual percentage change\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u003c/p\u003e\n\u003cp\u003eCMR: Crude mortality rate\u003c/p\u003e\n\u003cp\u003eSMR: Standardized mortality rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOABD: Older age bipolar disorder\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Approval and Consent to Participate: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent for Publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Material: All the data generated and analyzed for this study are included in this published article or its supplementary information files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting Interests: The authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: The authors received no funding for the research, authorship, and publication of this article.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: SK and MB collected, analyzed, and interpreted all of the data. SK and MB were major contributors to the writing of the manuscript. OF led data analysis and contributed to the writing of the manuscript. AT supervised data analysis. AT and RT provided feedback and revisions for the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eJain A, Mitra P. Bipolar Disorder. 2023 February 20.\u003c/li\u003e\n \u003cli\u003eGoes FS. Diagnosis and management of bipolar disorders. BMJ. 2023;381:e073591.\u003c/li\u003e\n \u003cli\u003eRowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology. 2018;8(9):251\u0026ndash;269.\u003c/li\u003e\n \u003cli\u003eHayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. 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Community Ment Health J. 2024;61(1):66\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eUnited States Census Bureau. Nation\u0026rsquo;s Urban and Rural Population Shift Following 2020 Census. 2022. https://www.census.gov/newsroom/press-releases/2022/urban-rural-populations.html. Accessed 4 Aug 2025.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStone DM, Crosby AE. Suicide Prevention. American Journal of Lifestyle Medicine. 2014;8(6):404\u0026ndash;420.\u003c/li\u003e\n \u003cli\u003eAndrilla CHA, Patterson DG, Garberson LA, Coulthard C, Larson EH. Geographic Variation in the Supply of Selected Behavioral Health Providers. American Journal of Preventive Medicine. 2018;54(6):S199\u0026ndash;S207.\u003c/li\u003e\n \u003cli\u003eIftikhar A, Alam FN, Ashraf DA, Qureshi SH, Akhtar M, Khan AI, et al. Where Do Patients With Cirrhosis Die? A CDC WONDER Analysis From 1999 to 2020. JGH Open. 2025;9(7):e70205\u0026ndash;n/a.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eJoinpoint model for BPAD Mortality Rates by Sex. *Indicates significant APC values.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"502\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 377px;\"\u003e\n \u003cp\u003eAge-Adjusted Mortality Rate (per 100,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eOverall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Joinpoints (Years of Joinpoint)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2002)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2001)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (2002, 2018, 2021)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-1 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e24.87* (12.59 to 46.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e38.67* (11.50-63.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e26.31*\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(16.44-45.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-2 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3.7619* (3.19-4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e3.81* (3.23 to 4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3.17* (0.95-4.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-3 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e10.06 (-0.82-12.75) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-2.12 (-8.78-6.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage APC (AAPC) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6.19* (5.50-7.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e6.34* (5.28-7.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e6.20* (5.49-7.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Joinpoint model for BPAD Mortality Rates by Race. *Indicates significant APC values.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"495\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 382px;\"\u003e\n \u003cp\u003eAge-Adjusted Mortality Rate (per 100,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eHispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eUnreliable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eUnreliable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Joinpoints (Years of Joinpoint)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (2002, 2017, 2020)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2003)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-1 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e31.28* (15.94-67.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e16.42* (7.79-35.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6.54* (5.68-7.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-2 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.01* (3.45-5.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.77* (3.09-4.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-3 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;18.59* (12.14-22.30) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e-- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-4 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-0.75 (-6.42-2.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage APC (AAPC) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8.87* (7.96-10.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.78* (4.97-7.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e6.54* (5.68-7.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Joinpoint model for BPAD Mortality Rates by Age. *Indicates significant APC values.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 466px;\"\u003e\n \u003cp\u003eCrude Mortality Rate (per 100,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e35-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e45-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e55-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e65-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e75-84 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e85+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUnreliable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e7.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Joinpoints (Years of Joinpoint)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1 (2006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (2001, 2007, 2016)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1 (2007)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2 (2001, 2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (2001, 2017, 2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3 (2002, 2016, 2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1 (2003)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-1 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13.29* (5.47-56.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e52.34* (31.99-74.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e15.73* (12.40-20.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e33.26* (12.23-56.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e24.52* (5.48-44.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e20.03* (12.66-32.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e13.50* (3.18-46.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-2 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.57 (-0.14-4.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e12.91* (8.50-17.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.73* (1.88-3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6.32* (5.76-7.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e3.27 (-1.21-3.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.62 (-0.16-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.59 (-0.38-2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-3 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.29 (-5.84-1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.01 (-5.27-5.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e13.61* (7.36-17.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e9.59* (6.71-13.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-4 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e5.70* (3.73-12.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.79 (-5.77-4.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e-1.28 (-6.17-1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage APC (AAPC) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e6.03* (4.19-9.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e8.62* (7.86-9.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6.89* (6.22-7.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7.79* (6.80-9.35)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e5.83* (4.89-7.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4.09* (3.56-4.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.49* (2.13-5.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eJoinpoint model for BPAD Mortality Rates by Urban or Rural status. *Indicates significant APC values.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"517\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 344px;\"\u003e\n \u003cp\u003eAge-Adjusted Mortality Rate (per 100,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Joinpoints (Years of Joinpoint)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (2001, 2007, 2016)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2002)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-1 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e24.45* (11.90-37.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e27.38* (13.09-59.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-2 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e6.42* (3.73-8.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e4.36* (3.57-5.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-3 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e2.14 (-1.31-2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-4 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e7.56* (5.08-13.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage APC (AAPC) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e6.35* (5.65-7.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e7.38* (6.26-9.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Joinpoint model for BPAD Mortality Rates by Census Region. *Indicates significant APC values.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"564\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 452px;\"\u003e\n \u003cp\u003eAge-Adjusted Mortality Rate (per 100,000)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003eNortheast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMidwest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Joinpoints (Years of Joinpoint)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2002)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (2001, 2008, 2016, 2021)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2003)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-1 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.51* (3.82-5.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27.93* (15.94-49.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e26.74* (13.37-40.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e18.68* (11.22-34.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-2 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.24* (2.81-3.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.43* (4.30-9.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3.33* (2.89-3.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-3 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.68 (-3.91-3.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-4 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9.05* (7.08-13.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPC Segment-5 (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-1.12 (-5.64-3.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage APC (AAPC) (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.51* (3.82-5.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.05* (5.19-6.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.53* (5.94-7.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003e5.74* (5.10-6.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-bipolar-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijbd","sideBox":"Learn more about [International Journal of Bipolar Disorders](http://journalbipolardisorders.springeropen.com/)","snPcode":"40345","submissionUrl":"https://submission.nature.com/new-submission/40345/3","title":"International Journal of Bipolar Disorders","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bipolar disorder, Psychiatry, Mental Health, Demographics, CDC WONDER","lastPublishedDoi":"10.21203/rs.3.rs-7658341/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7658341/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBipolar Affective Disorder (BPAD) is a class of mood disorders that poses a significant diagnostic challenge for clinicians. With its unknown etiology and the increasing disability burden it contributes to, BPAD necessitates further study to improve patient outcomes. Our study aimed to characterize the demographic trends in BPAD-related mortality using the CDC WONDER database.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe CDC WONDER database was utilized to collect data on the mortality burden from 1999\u0026ndash;2023. Data was stratified by race, sex, age, rural or urban designation, and census region. Data analysis was performed using Joinpoint analysis to help determine trends as well as statistical significance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOur study found that the overall mortality rate from BPAD increased throughout the study period and mortality increased with age. Additionally, the study found statistically significant increases in age adjusted mortality rate when analyzed in groups. Not only was mortality rate determined to be higher amongst females than their male counterparts, variation by race also persisted, with mortality being highest among the Non-Hispanic White cohort. Mortality burden varied by region, with higher mortality rates in rural areas than in urban areas and in the Midwest United States, compared to other census regions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOur study expands on prior research related to trends in mortality of BPAD and aims to highlight the disproportionate mortality burdens related to BPAD as a potential guide towards future management strategies. Further studies related to how the increased utilization of mental health resources, including telehealth, and focus on earlier treatment initiation can be useful to guide mental health practices in the future.\u003c/p\u003e","manuscriptTitle":"Trends in Bipolar Affective Disorder-Related Mortality in the United States, 1999-2023: A CDC WONDER Database Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 07:19:23","doi":"10.21203/rs.3.rs-7658341/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-08T16:45:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T04:33:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226532090687361233489684245263647597702","date":"2025-10-01T18:14:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145732746033813616111198924656456619996","date":"2025-09-29T14:18:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-25T09:59:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34199982207697718201420403213552073506","date":"2025-09-25T08:12:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-24T13:52:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T07:16:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-23T07:14:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Bipolar Disorders","date":"2025-09-19T11:48:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-bipolar-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijbd","sideBox":"Learn more about [International Journal of Bipolar Disorders](http://journalbipolardisorders.springeropen.com/)","snPcode":"40345","submissionUrl":"https://submission.nature.com/new-submission/40345/3","title":"International Journal of Bipolar Disorders","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c7f0895-fee5-416e-8f65-9fb312b59ce9","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:03:01+00:00","versionOfRecord":{"articleIdentity":"rs-7658341","link":"https://doi.org/10.1186/s40345-025-00408-4","journal":{"identity":"international-journal-of-bipolar-disorders","isVorOnly":false,"title":"International Journal of Bipolar Disorders"},"publishedOn":"2026-02-03 15:59:28","publishedOnDateReadable":"February 3rd, 2026"},"versionCreatedAt":"2025-10-08 07:19:23","video":"","vorDoi":"10.1186/s40345-025-00408-4","vorDoiUrl":"https://doi.org/10.1186/s40345-025-00408-4","workflowStages":[]},"version":"v1","identity":"rs-7658341","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7658341","identity":"rs-7658341","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}