Temporal and demographic trends in bipolar disorder-related mortality in the U.S. population: A 25-year nationwide...

Bipolar disorder (BD) is associated with significantly reduced life expectancy, yet national trends and demographic disparities in BD-related mortality remain under characterized.

To evaluate long-term patterns and sociodemographic disparities in BD-related mortality among U.S. adults from 1999 to 2023.

We conducted a retrospective, population-based analysis using the CDC WONDER Multiple Cause of Death database, including all deaths among adults aged 25 years and older where BD (ICD-10 code F31) was listed as an underlying or contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were estimated annually. Temporal trends were analyzed using Joinpoint regression, and mortality was stratified by sex, race/ethnicity, age group, census region, and urban-rural classification.

A total of 68,086 BD-related deaths occurred between 1999 and 2023. The AAMR increased from 0.26 to 1.13 per 100,000, with periods of accelerated rise from 1999 to 2001 and 2016-2021, followed by a slight decline. Females consistently exhibited higher AAMRs than males. Mortality rates were highest among non-Hispanic White adults, older adults, residents of the Midwest and West, and those in rural areas. Substantial state-level variation was also observed. The mortality gap persisted and widened across sex, racial, geographic, and age groups.

BD-related mortality has risen markedly over the past 25 years in the United States, with persistent disparities by sex, race/ethnicity, region, and rurality. These findings underscore the urgent need for integrated clinical care, targeted prevention strategies, and policies to reduce preventable deaths in this high-risk population.