Trends, geographic distribution, and disease burden of bipolar disorder in Ecuador (2011–2021): An analysis of hospital discharge data

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Abstract
This retrospective observational study aims to evaluate the incidence, disease burden, and geographic distribution of bipolar disorder based on hospital records in Ecuador over an eleven-year span. Hospital discharge data, publicly available from 2011 to 2021, were analyzed to assess incidence, DALYs, and the spatial distribution of hospitalized cases during this period. Between 2010 and 2021, a total of 6,821 hospitalized cases of bipolar disorder were documented in Ecuador, comprising 2,423 males and 4,398 females. The incidence rate peaked in 2019, with the lowest rate reported in 2020. There was no linear association between time and incidence rates or number of cases, but a significant increase was observed from 2017 to 2019 (p < 0.0001). The incidence rate was significantly higher in females compared to males (p < 0.0001). The average annual incidence was 3.47 cases per 100,000 person-years. The mean age at diagnosis was 40.76 years, with females being diagnosed at a younger age than males (p = 0.01548). Bipolar disorder-related deaths totaled 27 (12 males, 15 females). The burden of disease, expressed in DALYs, ranged from 66.769 to 126.98 per 100,000 population, with the hospitals from the private sector contributing most to the average DALYs. YLDs represented over 99% of the total burden. This study highlights the significant gender differences and temporal trends in bipolar disorder incidence in Ecuador, emphasizing the need for targeted public health strategies.

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