There was a more than twofold increase in the rate of suspected self-poisoning suicide cases between 2011 and 2018, according to a new study that looked at more than 1.6 million such cases. Here’s what else you need to know: •Overall trends: Cases of suicide attempts by self-poisoning doubled in those aged 10-18 between 2011 and 2018, rising from around 39,000 to more than 78,000. •Gender: More girls than boys attempted suicide by self-poisoning. The rate of intentional attempts among girls 10-18 also steadily increased from 2011-2018. •Outcomes: The number of serious outcomes — including death and hospitalizations — as a result of the poisoning increased 235% between 2000 and 2018, and more than 1,400 children died.

1. Sex- and Age-specific Increases in Suicide Attempts by
Self-Poisoning in the United States among Youth and
Young Adults from 2000 to 2018
Henry A. Spiller, MS, DABAT1,2
, John P. Ackerman, PhD3,4
, Natalie E. Spiller, BS5
, and
Marcel J. Casavant, MD1,2
Objective To evaluate the incidence and outcomes from intentional suspected-suicide self-poisoning in children
and young adults ages 10-24 years old from 2000 to 2018.
Study design Retrospective review of intentional suspected-suicide self-poisoning cases reported to the Na-
tional Poison Data System from US poison centers from 2000 to 2018 for patients 10-24 years old. For comparison
of annual rates, population data by year of age were obtained from the US Census Bureau. We evaluated changes in
the annual incidence, the annual rate per 100 000 population, and the medical outcome by patient age and sex.
Results There were 1 627 825 intentional suspected-suicide self-poisoning cases, of which 1 162 147 (71%) were
female. In children 10-15 years old from 2000 to 2010, there was a decrease in number and rate per 100 000 pop-
ulation followed by a significant increase (from 125% to 299%) from 2011 to 2018. In children 10-18 years old, the
increase from 2011 to 2018 was driven predominantly by females. In 19-24 years old age groups, there was a tem-
poral delay and reduced increase in slope compared with the younger groups. There were 340 563 moderate out-
comes, 45 857 major outcomes, and 1404 deaths. The percentage of cases with a serious outcome, major effect, or
death increased over time and with age.
Conclusions The incidence and rate of suicide attempts using self-poisoning in children less than 19 years old
increased significantly after 2011, occurring predominantly in young girls. There has been an increase in the severity
of outcomes independent of age or sex. (J Pediatr 2019;-:1-8).
S
uicide is the second leading cause of death in people aged 10-24 years.1
The rates of suicide among 10- to 19-year-olds,
which had been decreasing before 2007, increased 56% from 2007 to 2016 and the rates of suicide among 10- to 14-year-
old girls nearly tripled in that same timeframe.2
An important factor in suicides is the rate of attempted suicides. Not
only are suicide attempts associated with emotional distress and a history of psychopathology, but they are one of the strongest
predictors of subsequent suicide.3-6
The ratio of attempted suicides to suicides among adolescents is estimated to be 50:1 to
100:1.7,8
However, there are limited recent data on suicide attempts. Data collected from 49 US children’s hospitals indicate
that from 2008 to 2015 hospitalizations for suicidal ideation and suicidal encounters doubled among children age 5-17 years
and there are similar increases in percentages of females compared with males who struggle with suicidal thoughts or attempt
suicide.9
Data from the 2017 Youth Risk Behavior Survey, which is administered anonymously to a representative sample of
high school students in the US, indicate that 17.2% of high school students seriously consider suicide in a given year, 8.6%
self-report attempting suicide, and 2.2% self-report receiving medical care for a suicide attempt.10
Adolescent girls specifically
seem to be at an increasing risk for thinking about suicide, attempting suicide, and being diagnosed with mood disorders.11
There is a longstanding pattern of males dying by suicide more frequently than females, whereas females attempt suicide
more frequently than males. This paradox is at least in part associated with choice of method and method-specific lethality.12
For both males and females, self-poisoning is the leading cause of suicide attempts and third leading cause of suicide in ado-
lescents, with higher rates in females for both attempts and suicides.8,9,13
As a method, self-poisoning has a relatively low fatality
rate (<5%) and suicide attempts by self-poisoning are more likely to end in
rescue.14
Attempted suicide is a significant predictor of future suicide and survi-
vors of attempted suicide given follow-up psychiatric care had significantly lower
likelihood of subsequent suicide.15-17
Exploration of suicide attempts by self-
poisoning may provide an important window into one of the most common
methods of suicide attempt.
From the 1
Central Ohio Poison Center, Nationwide
Children’s Hospital, 2
The Ohio State University, College
of Medicine, Department of Pediatrics, 3
Center for
Suicide Prevention & Research, Behavioral Health
Services, Nationwide Children’s Hospital, 4
The Ohio
State University, College of Medicine, Department of
Psychiatry and Behavioral Health, Columbus OH; and the
5
School of Medicine, University of Louisville, Louisville,
KY
The authors declare no conflicts of interest.
0022-3476/$ - see front matter. ª 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jpeds.2019.02.045
NPDS National Poison Data System
PCC Poison Control Center
1
ORIGINAL
ARTICLES

2. In this study, we use the National Poison Data System
(NPDS) database from January 2000 to November 2018 to
investigate intentional suspected suicide self-poisoning in
children and young adults ages 10-24 years old.
Methods
A network of regional Poison Control Centers (PCC) in the
US, covering the full population of all 50 states and the Dis-
trict of Columbia, offer free, confidential medical advice
24 hours per day by telephone through the Poison Help
Line. During the case management by PCCs, multiple mea-
sures are recorded by the healthcare professionals (nurses,
pharmacists, and physicians) managing the poisoned pa-
tients including: reason for poisoning, age, substance, clinical
effects, therapies, and medical outcomes. Information from
these cases, including updates from continued follow-up,
are uploaded in near real time to the NPDS, a database
managed by the American Association of Poison Control
Centers. The term “exposure” is used by PCCs to designate
an individual case/patient who has been exposed to a possible
poison, because it is route neutral, allowing cases from inges-
tion, inhalation, injection, or dermal exposure.
Case Selection Criteria
The NPDS was queried for all human exposure cases that had
a reason for exposure of “intentional–suspected suicide” and
age of 10-24 years from January 1, 2000, through November
30, 2018. The number of cases for the full year 2018 were esti-
mated using January to November data (334 of 365 days).
Age groups were classified by single years of age and from
these we created composite age groups (10-12, 13-15, 16-
18, 19-21, and 22-24). Only cases with an exact age were
included. Cases using the NPDS estimated age groups of 6-
12, 13-19, and 20-29 years were excluded. Cases with a med-
ical outcome coded as “confirmed non-exposure” or “unre-
lated effect, the exposure was probably not responsible for the
effect(s)” were excluded.
Study Variables
Variables included in this study were age, sex, year of expo-
sure, reason for exposure, management site, and medical
outcome. The accuracy of coding in NPDS for demographics
(age, sex) and reason for exposure has been reported as
greater than 95%.18
Data were analyzed for single-year age
groups, composite age groups, and year of occurrence.
Data are presented on composite age groups. Comparisons
were made based on sex and medical outcome. After initial
analysis, an inflection point was discovered at the years
2010-2011. Data were then additionally analyzed for 2 time
periods, from 2000 to 2010 and from 2011 to 2018. EpiInfo7
(Centers for Disease Control and Prevention) was used to
conduct data analysis. ANOVA was used to evaluate annual
means of number and rate of intentional suicides, and out-
comes (moderate, major death and serious). For differences
between 2000-2010 and 2011-2018 tests of means used the
Mann-Whitney/Wilcoxon (Kruskal-Wallis) 2-sample test.
Statistical significance was established at an a of 0.05. Slope
calculation and trend fit (r2
) used Microsoft Excel 2010
(v14.0; Microsoft, Redmond, Washington). Descriptive sta-
tistics with 95% CIs were calculated.
Medical outcomes and reason for exposure were deter-
mined by the providers managing the exposures at the indi-
vidual PCC using the standard NPDS definitions, allowing
for consistent data reporting among individual PCCs and
across the years of data. Likely owing to the unique selection
criteria of intentional self-poisoning, 96%-99% of all patients
selected (depending on the year and patient age) were
managed in a healthcare facility requiring direct physician
attendance. This allowed for the robust capture of final
assessment of reason for exposure, and clinical outcome
based on continued follow-up and consultation between
the individual PCC and the treating facility. Definitions of
medical outcomes were standard NPDS definition used by
all PCCs: (1) no effect, (2) minor effects involved the devel-
opment of quickly resolving, minimally bothersome symp-
toms, (3) moderate effects entailed non–life-threatening
symptoms that were more pronounced, prolonged, or sys-
temic in nature and typically required some form of treat-
ment (eg, sinus tachycardia, discrete seizure, hypertension
not requiring intervention), (4) major effects included symp-
toms that were life-threatening or resulted in significant
disability or disfigurement (eg, respiratory depression, ven-
tricular arrhythmias, hypotension requiring pressor sup-
port), and (5) death.19
For the purposes of analysis, an
additional group was created by the authors labeled serious
outcome by combining 3 existing outcome categories of
moderate effect, major effect, and death.20
Definitions of
“Intentional–suspected suicide” are defined in NPDS as an
exposure resulting from the inappropriate use of a substance
for self-harm or for self-destructive or manipulative reasons.
This is differentiated from other intentional exposures such
as “Intentional–Misuse,” defined as an exposure resulting
from the intentional improper or incorrect use of a substance
for reasons other than the pursuit of a psychotropic effect,
and “Intentional–Abuse,” defined as an exposure resulting
from the intentional improper or incorrect use of a substance
where the patient was likely attempting to gain a high,
euphoric effect, or some other psychotropic effect, including
recreational use of a substance for any effect.
This study was deemed exempt by the institutional review
board of the authors’ institution.
Results
There were 1 647 681 cases reported to US poison centers
with the reason of intentional suspected suicide and with
an age of 10-24 years from January 2000 to November 30,
2018. There were 19 856 cases (1%) with an estimated age
(45 patients in 6-12 group, 5038 in the 13-19 group, and
19 856 in the 20-29 group) leaving 1 627 825 cases for anal-
ysis. The majority (n = 1 162 147 [71%]) were female
THE JOURNAL OF PEDIATRICS www.jpeds.com Volume - - 2019
2 Spiller et al

3. (Table I). For the total group (ages 10-24) from 2000 to 2018
there was a significant increase of 3.4%/year in the number of
intentional suicide patients (ANOVA; P .01). This increase
showed specific temporal, age, and sex trends. From 2000 to
2010, there was a 1.9% annual increase in the number of
intentional suspected suicide patients, followed by a 3.9%
annual increase from 2011 to 2018. This increase occurred
disproportionately in children ages 10-18 years and in
females.
Age and Sex
In children 10-12 years old and 13-15 years old, there was a
decline in the number and rate per 100 000 population of
annual intentional suspected suicide cases from 2000
through 2010 followed by a dramatic and persistent increase
from 2011 to 2018 (P .01; Table II and Figure). In children
10-12 years old and 13-15 years old from 2000 to 2010, the
decrease in the number and rate ranged from 10% to 20%,
with a descending slope of À0.17 to À0.75 and 13%-19%,
respectively. From 2011 to 2018, there was an increase in
the number and rate that ranged from 126% to 299% and
a positive slope of +1.3 to +7.1 (r2
0.9; P .01) and from
126% to 229%, respectively (P .01). In the 16- to 18-
year-old age group comparing changes from 2000 to 2010
vs 2011 to 2018, there was a significant increase in the
annual number (P .01), rate (P .01), and slope; from
15% to 62%, 4% to 70%, and 0.15 to 6.1, respectively. In
the age groups 10-12, 13-15, and 16-18 years, the increase
from 2011 to 2018 was driven primarily by females
(Figure). The percentage of females in the age groups 10-
12, 13-15, and 16-18 increased significantly when
comparing 2000-2010 and 2010-2018 (P .05). The
percentage of females in the 10- to 12-year age groups
remained steady from 2000 to 2010 (73% to 75%) and
increased continuously after 2011 to 84% in 2018. In the
age groups of 13-15 and 16-18 years, as the annual number
of cases decreased during 2000-2010, the percentage of
females decreased, from 82% to 78% and from 73% to
68%, respectively. In these same age groups, when the
annual number of cases increased from 2011 to 2018, the
percentage of females increased, from 78% to 82% and
from 68% to 74%, respectively. In the age groups 19-21,
and 22-24 years, females ranged from 60% to 65% and did
not change over the 19-year study period. There was no
significant difference between 2000-2010 and 2011-2018.
In the age groups 19-21 and 22-24 years, there was a 4%
annual increase across the years 2000-2018 (ANOVA
P .01). However, in contrast with the younger age groups,
there was a delay in the inflexion point to 2013-2014, with a
decreased slope compared with the younger groups.
Outcomes
There were 340 563 moderate outcomes, 45 857 major out-
comes, and 1404 deaths. As shown in Table III, both the
number of cases per year with a serious outcome and the
percentage of total cases that resulted in a serious outcome
increased. The greatest increases in rate and number with
serious outcome occurred in the 10- to 12-year-old and 13-
to 15-year-old age groups. However, these increases
occurred in all age groups, for both males and females, and
were primarily influenced by the increase in moderate
outcomes. The highest number of cases with a serious
outcome occurred among youth in age groups 13-15 and
16-18 years. The percentage of cases per age group with a
serious outcome, major effect, or death increased with age.
In children less than 19 years of age, the annual number of
suicide attempts by self-poisoning doubled from 2000 to
2018, from 39 367 to 78 474, respectively. During this same
period, serious outcomes increased 235% from 6167 to
20 639, respectively. From 2000 to 2018, the total number
cases in the NPDS for this age group (10-18 years) for all rea-
sons (intentional, unintentional, adverse reactions, etc) did
not change (0.2% increase per year), suggesting that the in-
crease in intentional suicide by self-poisoning cases is inde-
pendent of use of poison centers or cases reported to the
NPDS.
Discussion
Our findings converge with the growing evidence of wors-
ening outcomes related to suicidal behavior among children
and adolescents.10,11,21
A number of findings in the present
study add additional evidence of changes in temporal trends,
age and sex differences, and changes in outcome that are
occurring. We found that, although overall suicide attempt
rates are increasing, an inflexion point occurred in 2011
with a significant increase in rates in children less than
18 years of age, that this increase in suicide attempts by
self-poisoning has been predominantly driven by girls, and
that there has been an increase in the severity of suicide
Table I. Number of intentional suicide cases by age group, sex, and medical outcome
10-12 years 13-15 years 16-18 years 19-21 years 22-24 years
Male 8075 (20) 68 935 (17.7) 142 400 (27.4) 135 543 (35.4) 113 780 (38.3)
Female 31 644 (80) 320 685 (82.2) 374 756 (72.4) 246 480 (64.4) 182 075 (61.3)
Female, pregnant 123 (0.1) 1183 (0.2) 833 (0.2) 1313 (0.4)
Total intentional suicide exposures 39 719 389 743 518 339 382 856 297 168
Outcome
Moderate outcome 7115 (17.9) 74 792(19.2) 105 443 (20.3) 83 516 (21.5) 69 696 (23.4)
Major outcome 761 (1.9) 7941 (2.0) 13 292 (2.6) 12 481 (3.3) 11 382 (3.8)
Death 19 (0.05) 128 (0.03) 328 (0.06) 478 (0.13) 451 (0.15)
Values are number (%).
- 2019 ORIGINAL ARTICLES
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young
Adults from 2000 to 2018
3

4. attempts independent of age or sex that has resulted in wors-
ening outcomes during this time period.
The current study design cannot provide a set of causal ex-
planations regarding why suicide attempts via self-poisoning
are occurring at higher rates among young females in the US
and why those attempts seem to be made with increasing
severity among all youth. Because of the broad range of bio-
logical and psychosocial risk factors linked to youth suicide,
it is likely that multiple psychosocial, technological, and
perhaps economic aspects in the last decade may produce
cascading effects.22-24
During the period when the increased
rates of suicide attempts are most pronounced (after 2011),
there have been a number of society-shifting changes that
may impact a number of these underlying factors, including
the advent of social media and smartphones, the manner and
frequency with which youth relate to one another, and the
impact of the opiate crisis. Several recent studies compared
the temporal trend after 2011 of increased rate of depressive
symptoms and suicide among adolescents 12-17 years of age
with increased new media screen time and found clear posi-
tive associations.11,25
Similar to our findings, they did not
find this temporal trend in young adults.11
However, there
are conflicting results looking at increased screen time,
increased social media use, and depressive symptoms in
youth and adolescents.25,26,27
It is unclear the level of impact
of the opiate crisis on families with children may have had on
the increasing rates of suicide attempt by self-poisoning.
Children of parents with opiate addiction disorders have
increased risk of mood and behavioral disorders.30-32
Although this may be a factor in the increase, it is unclear
why there should be such a disproportionate number of
young females vs males.
A concerning finding is the increase in severity of out-
comes over all age groups and both sexes, with nearly
one-third of all intentional suicide patients having a re-
ported serious outcome. Acquired capability, defined as
an increased ability to end one’s life by engaging in succes-
sive approximations toward enacting lethal self-injury,
should be considered in the context of the increase in
severity.28
Access to knowledge about specific methods to
engage in lethal self-harm and exposure to the suicidal
behavior of peers has undoubtedly increased with the ability
to search online for readily available information, publicly
posted information, and the increase of what is shared on
social media networks. Youth are now increasingly exposed
online to others struggling with suicidal ideation and
engaging in self-injurious behaviors. Research on suicide
contagion suggests that such exposure can increase suicidal
behavior within peer networks and that youth are particu-
larly vulnerable to suicide contagion.29
There is also an as-
sortative component at play where youth most at risk for
engaging in suicidal behavior are linking up with other
youth who share information about their own suicidal
thoughts or behaviors with minimal supervision or profes-
sional support to help navigate a crisis. This factor may
contribute to the continued increase in the percentage of
serious medical outcomes seen in our study.
TableII.Annualnumberofintentionalsuicidecasesperyearandrateper100000populationperyearbypatientagegroupandsex
Ages,ySex
Totalno.andmeanperyear
(95%CI),2000-2010
Totalno.andmeanperyear
(95%CI),2011-2018
Changein
annualnumber,
2000vs2010,%
Changein
annualnumber,
2010vs2018,%
Rate/100000
population,
Mean,2000-2010
Rate/100000
population,mean,
2011-2017
Percentchange
inratemeans,
2000-2010vs
2011-2017,%
Changein
rate/100000
population,
2000vs2010,%
Changein
rate/100000
population,
2010vs2017,%
10-12Male366/year(Æ48),4031505/year(Æ143),*4037À27+1535.77.227À26106
Female1033/year(Æ116),113632532/year(Æ921),*20254À17+33816.837.6123À17268
Total1401/year(Æ161),154093089/year(Æ1058),*24310À20+29911.122.198À19229
13-15Male3072/year(Æ58),337994387/year(Æ766),*35094+7+9047.465.138663
Female12936/year(Æ761),14229922274/year(Æ4885),*178192À14+136209.4352.368.À17143
Total16018/year(Æ752),17620326693/year(Æ5572),*213540À10+126126.5205.963À13126
16-18Male6845/year(Æ457),752948368(Æ976),*66942+32+35103.6124.3201933
Female16957/year(Æ448),18652223624(Æ4660),*188997+9+75272.6366.935À286
Total23830/year(Æ847),26213432026/year(Æ5401),*256205+15+62186.0243.231470
19-21Male6730/year(Æ578),740387687/year(Æ436),*61496+43+12102.9111.48277
Female12191/year(Æ918),13409814661/year(Æ2437),*117291+29+40190.6217.7141340
Total18597/year(Æ1164),20457022286/year(Æ2190),*178286+34+29146.1164.1121928
22-24Male5464/year(Æ578),601006710/year(Æ195),*53680+70+1186.996.01148À0.3
Female8958/year(Æ689),9854110574/year(Æ578),*84590+48+16147.9156.76299
Total14436/year(Æ1275),15879417297/year(Æ766),*138374+56+14117.2126.38365
*P.05Mann-Whitney/Wilcoxon(Kruskal-Wallis)2-samplestest.Comparisonofmeans2000-2010vs2011-2018.
THE JOURNAL OF PEDIATRICS www.jpeds.com Volume -
4 Spiller et al

5. Given the current rates of youth suicidal behavior,
which have increased consistently over the past 8 years,
early identification, assessment, and treatment of those at
high-risk needs to occur. There are many places where
identification can occur, but most notably screening dur-
ing primary care visits and school suicide prevention pro-
gramming would provide viable opportunities for
universal suicide prevention.33
Media and awareness cam-
paigns as well as evidence-based training for practitioners
to intervene with youth showing warning signs of suicide
are also critical.33
Access to crisis resources and a reduc-
tion of stigma associated with getting help are also critical
next steps.
The temporal changes that seem to correlate with changes
in the way youth are spending their time and connecting with
others is concerning and suggests that this issue should be an
area of future research. Important areas of concern for future
research are why the rise in rates is so steep in the young age
groups, why so prominent in females and why is the severity
increasing.
Figure. Intentional suicide self-poisoning exposures, number per year and rate per 100 000 population per year by age groups
and sex. A, Among those 10-12 years old. B, Among those 13-15 years old. C, Among those 16-18 years old. D, Among those 19-
21 years old. E, Among those 22-24 years old.
- 2019 ORIGINAL ARTICLES
Sex- and Age-specific Increases in Suicide Attempts by Self-Poisoning in the United States among Youth and Young
Adults from 2000 to 2018
5

6. Figure. Continues
THE JOURNAL OF PEDIATRICS www.jpeds.com Volume -
6 Spiller et al

7. Ultimately, suicide attempts are driven by disconnection,
hopelessness, emotional pain, and a lack of personal mean-
ing. Supporting youth in connecting, accessing support
when needed, and cultivating daily meaning will begin to
address many of the concerns that lead to suicidal behavior.
However, strong empirically supported therapies and medi-
cal treatments are also necessary to support those at greatest
risk, and these interventions should increasingly include
suicide-specific care models.
The NPDS only includes exposures voluntarily reported
during routine operation of the country’s 55 poison centers;
therefore, this study underestimates the actual number of
suspected suicide attempts by self-poisoning in the US. Calls
to PCCs are self-reported by patients, parents, caregivers, and
healthcare professionals seeking toxicological advice and
cannot be fully verified by the PCCs or the American Associ-
ation of Poison Control Centers. The true number of inten-
tional suicide and suicide attempts by self-poisoning is not
known. However, a comparison of the NPDS with the Na-
tional Electronic Injury Surveillance System–All Injury Pro-
gram on children with pharmaceutical ingestion receiving
emergency room care showed remarkable similarity number
of patients, ages, reason for ingestion, substances involved in
the poisoning, and level of care received, suggesting that the
NPDS numbers may be near the actual number of pharma-
ceutical poisoning in this age group.34
NPDS allows only bi-
nary (male or female) sex identification and, therefore, does
not identify the frequency of patients with alternative or
changing sex identifications. Suicide attempts are dispropor-
tionately made by females and ingestion is also dispropor-
tionately used as a method by females, so these results may
not generalize to males at risk for suicide. The NPDS does
not collect information on ethnicity. As such, we were unable
to analyze or comment on any impact ethnicity may have on
the trends reported in our study. Despite these limitations,
the NPDS is a valuable tool for evaluating the epidemiology
of suspected suicide by self-poisoning at the national level. n
Submitted for publication Dec 18, 2018; last revision received Feb 5, 2019;
accepted Feb 28, 2019.
Reprint requests: Henry A. Spiller, MS, DABAT, Central Ohio Poison Center,
700 Children’s Drive, Columbus, OH 43205. E-mail: Haspiller5@gmail.com
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TableIII.Medicaloutcomesbyagegroup2000-2010vs2011-2018
Ages,y
Annualmeanno.ofseriousoutcome
exposures(95%CI)for2000-2010
vs2011-2018
Changeinannualmeanof
seriousoutcomeexposures
(2000-2010vs2011-2018,
respectively)
Annualmeanpercentof
totalcaseswithserious
outcome(95%CI)
2000-2010and2011-2018
Changeinpercentof
totalcaseswith
seriousoutcome2000-2010
and2011-2018
Annualmean
(95%CI)percentoftotal
caseswithmajoroutcome
2000-2010and2011-2018
Changeinpercent
oftotalcaseswith
majoroutcome2000-2010
and2011-2018
10-12223/year(CIÆ19.8)vs665/year(CIÆ257)*+196%16.1%(CIÆ1.3)vs21.4%(CIÆ2.5)*+33%1.77(CIÆ0.24)vs1.97(CIÆ0.19)+11%
13-152888/year(CIÆ159)vs6386/year(CIÆ1534)*+121%18.2%(CIÆ0.9)vs23.7%(CIÆ1.6)*+30%1.9(CIÆ0.12)vs2.2(CIÆ0.12)*+14%
16-184723/year(CIÆ516)vs8388/year(CIÆ1687)*+78%19.7%(CIÆ1.5)vs26.0%(CIÆ0.9)*+32%2.4(CIÆ0.15)vs2.7(CIÆ0.13)*+11%
19-214045/year(CIÆ568)vs6498/year(CIÆ812)*+61%21.5%(CIÆ1.7)vs29.1%(CIÆ1.9)*+35%3.0(CIÆ0.14)vs3.5(CIÆ0.11)*+15%
22-243458/year(CIÆ556)vs5438/year(CIÆ467)*+86%23.6%(CIÆ1.9)vs31.4%(CIÆ1.4)*+33%3.5(CIÆ0.19)vs4.1(CIÆ0.2)*+26%
*P.05,Mann-Whitney/Wilcoxon(Kruskal-Wallis)2-sampletest.Comparisonofmeans2000-2010vs2011-2018.
- 2019 ORIGINAL ARTICLES
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Adults from 2000 to 2018
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