{
  "plan": {
    "method": "poisson-rate",
    "outcome_column": "deaths",
    "time_columns": [
      "year"
    ],
    "filters": [
      {
        "column": "series",
        "value": "Osmotic demyelination syndrome (G37.2), any mention on certificate",
        "operator": "==",
        "reason": "Single series: G37.2 as any mention (multiple cause) on the certificate"
      }
    ],
    "group_columns": [],
    "weight_column": null,
    "share_weight_column": null,
    "strata_column": null,
    "psu_column": null,
    "covariates": [],
    "categorical_covariates": [],
    "sensitivity_covariates": [],
    "sensitivity_categorical_covariates": [],
    "group_recode": {},
    "contrasts": [],
    "reference_group": null,
    "series_kind": "discrete",
    "window_start": "1999",
    "window_end": "2024",
    "denominator_column": "population",
    "age_column": null,
    "standard_population": "us-2000-11",
    "suppressed_bound": null,
    "rate_per": 100000,
    "breakpoint": null,
    "minimum_points": 8,
    "exclude_incomplete": true,
    "rationale": "Annual counts of deaths with G37.2 mentioned on the certificate are small, with a population denominator, so a Poisson rate model with log(population) offset is appropriate. The primary, pre-specified fit is a log-linear trend across 1999-2024 without a breakpoint, reported as an annual percent change in the crude rate. Because the counts are overdispersed, uncertainty should be reported from quasi-Poisson or negative binomial variance, and the plan states plainly whether the interval includes no change. Sensitivity fits requested after review: (a) restrict the window to 1999-2018 to see the trend before the late cluster; (b) drop 2020-2021 (pandemic years) from the full series; (c) optionally an interrupted model with a guideline-related breakpoint at 2014 (exploratory only; 2007 and 2013 are alternative exploratory dates). The series shape should be described explicitly (roughly level for about two decades, then elevated in a few late years) and the fitted slope reconciled with the endpoint comparison by also presenting 1999 and 2024 values alongside multi-year averages (1999-2003 versus 2020-2024). Counts and crude rates per 100,000 are reported for each year. No age adjustment is done: only crude rates are reported, and the standard population setting is not used. The data holds the single multiple-cause definition only; underlying-cause-only deaths and WONDER suppression/unreliability flags are not in this dataset and are not analysed.",
    "limitations": [
      "Ecological, population-level death-certificate data: cannot establish causes of change or any link to treatment practice or guideline publication.",
      "Any-mention counts depend on certification and coding practice, which may change over time and may not reflect true incidence of osmotic demyelination syndrome.",
      "The 2019-2023 period overlaps the COVID-19 pandemic; any late elevation may reflect pandemic-era mortality or certification patterns rather than a real long-run trend.",
      "Counts are small, so year-to-year noise is large and trend estimates are imprecise; overdispersion means unadjusted Poisson intervals would overstate precision, and the slope is sensitive to a few late years.",
      "Crude rates are not age-adjusted; changes in population age structure can affect the crude rate.",
      "Data come from two WONDER databases (D77 for 1999-2020, D157 for 2021-2024) with a seam between 2020 and 2021; overlap years 2018-2020 were checked and matched, but residual differences cannot be fully excluded.",
      "Population denominators change in method across years (intercensal, Census counts, bridged-race and single-race postcensal estimates, Modified Blended Base for 2021+), which may introduce small discontinuities in rates.",
      "Source notes flag data-quality caveats for specific states and years (R99 excess in Georgia 2008-2009, New Jersey 2009, California 2000-2001; a revision of 125 deaths in 2014) that could slightly affect cause coding.",
      "Only final data are used; provisional data are not included. Underlying-cause-only counts and WONDER suppression/unreliability flags are not available in this dataset, so these planned elements are not addressed.",
      "Breakpoint analyses at 2007, 2013 or 2014 are exploratory and cannot support causal inference."
    ]
  },
  "n_rows_input": 26,
  "n_rows_analysed": 26,
  "n_suppressed_dropped": 0,
  "series": [
    {
      "group": "",
      "n": 26,
      "first_period": "1999",
      "last_period": "2024",
      "first_value": 33.0,
      "last_value": 37.0,
      "min": 24.0,
      "min_period": "2002",
      "max": 60.0,
      "max_period": "2020",
      "mean": 36.92307692307692,
      "median": 35.0,
      "absolute_change": 4.0,
      "percent_change": 12.121212121212121,
      "by_period": [
        {
          "period": "1999",
          "value": 33.0,
          "crude_rate": 0.011826254347725306
        },
        {
          "period": "2000",
          "value": 35.0,
          "crude_rate": 0.012436842780817498
        },
        {
          "period": "2001",
          "value": 29.0,
          "crude_rate": 0.010176547125984302
        },
        {
          "period": "2002",
          "value": 24.0,
          "crude_rate": 0.008344192575648267
        },
        {
          "period": "2003",
          "value": 34.0,
          "crude_rate": 0.011719776032460305
        },
        {
          "period": "2004",
          "value": 33.0,
          "crude_rate": 0.011270287875733724
        },
        {
          "period": "2005",
          "value": 32.0,
          "crude_rate": 0.0108284949502955
        },
        {
          "period": "2006",
          "value": 39.0,
          "crude_rate": 0.013070584993000468
        },
        {
          "period": "2007",
          "value": 30.0,
          "crude_rate": 0.009959127508326187
        },
        {
          "period": "2008",
          "value": 35.0,
          "crude_rate": 0.011509600292430663
        },
        {
          "period": "2009",
          "value": 34.0,
          "crude_rate": 0.011083166717208624
        },
        {
          "period": "2010",
          "value": 36.0,
          "crude_rate": 0.011660087537848078
        },
        {
          "period": "2011",
          "value": 32.0,
          "crude_rate": 0.010269842782860122
        },
        {
          "period": "2012",
          "value": 30.0,
          "crude_rate": 0.009556756365532425
        },
        {
          "period": "2013",
          "value": 39.0,
          "crude_rate": 0.01233674223565538
        },
        {
          "period": "2014",
          "value": 40.0,
          "crude_rate": 0.01254480628460673
        },
        {
          "period": "2015",
          "value": 38.0,
          "crude_rate": 0.011822580893054116
        },
        {
          "period": "2016",
          "value": 29.0,
          "crude_rate": 0.008974785133818055
        },
        {
          "period": "2017",
          "value": 36.0,
          "crude_rate": 0.011052465568975493
        },
        {
          "period": "2018",
          "value": 26.0,
          "crude_rate": 0.007947001228734764
        },
        {
          "period": "2019",
          "value": 45.0,
          "crude_rate": 0.013709500790372522
        },
        {
          "period": "2020",
          "value": 60.0,
          "crude_rate": 0.018210285659197
        },
        {
          "period": "2021",
          "value": 59.0,
          "crude_rate": 0.017776773708103478
        },
        {
          "period": "2022",
          "value": 38.0,
          "crude_rate": 0.011401565765625028
        },
        {
          "period": "2023",
          "value": 57.0,
          "crude_rate": 0.017019249024442466
        },
        {
          "period": "2024",
          "value": 37.0,
          "crude_rate": 0.01087880171633855
        }
      ]
    }
  ],
  "findings": [
    {
      "series": "",
      "method": "poisson-rate",
      "n_points": 26,
      "events": 960,
      "rate_ratio_per_period": 1.0112803512858162,
      "rate_ratio_ci_lower": 1.0009047827861837,
      "rate_ratio_ci_upper": 1.0217634748931295,
      "percent_change_per_period": 1.128035128581617,
      "p_value": 0.03301990652644194,
      "dispersion": 1.4693432384161005,
      "variance_scale": 1.4693432384161005,
      "leave_one_out": {
        "n_refits": 26,
        "n_refits_interval_excludes_no_change": 21,
        "lowest_rate_ratio": 1.0083867921769774,
        "lowest_when_left_out": "2020",
        "highest_rate_ratio": 1.0136233474398246,
        "highest_when_left_out": "2024"
      },
      "truncation_sensitivity": [
        {
          "last_period": "2023",
          "rate_ratio_per_period": 1.0136233474398246,
          "rate_ratio_ci_lower": 1.0027969628800888,
          "rate_ratio_ci_upper": 1.0245666156828723,
          "p_value": 0.013520587596781807
        },
        {
          "last_period": "2022",
          "rate_ratio_per_period": 1.0106239392814302,
          "rate_ratio_ci_lower": 0.9991802516212824,
          "rate_ratio_ci_upper": 1.0221986923695132,
          "p_value": 0.06893876777962062
        },
        {
          "last_period": "2021",
          "rate_ratio_per_period": 1.01241644650385,
          "rate_ratio_ci_lower": 1.0001744028115103,
          "rate_ratio_ci_upper": 1.024808331697176,
          "p_value": 0.04680516052034819
        },
        {
          "last_period": "2020",
          "rate_ratio_per_period": 1.0071719477463081,
          "rate_ratio_ci_lower": 0.9949184076333762,
          "rate_ratio_ci_upper": 1.0195764039988424,
          "p_value": 0.2525219059325322
        },
        {
          "last_period": "2019",
          "rate_ratio_per_period": 0.9992063385325637,
          "rate_ratio_ci_lower": 0.9871051260843648,
          "rate_ratio_ci_upper": 1.0114559033080341,
          "p_value": 0.8983752236565791
        },
        {
          "last_period": "2018",
          "rate_ratio_per_period": 0.9950223129035514,
          "rate_ratio_ci_lower": 0.9819636406912912,
          "rate_ratio_ci_upper": 1.0082546462503799,
          "p_value": 0.45909799699532516
        }
      ],
      "interpretation": "A rate ratio of 1.011 per period means the rate changes by +1.1% each period, holding the population offset. Standard errors are quasi-Poisson: scaled by the Pearson dispersion, floored at 1 (variance_scale). leave_one_out refits without each period in turn; truncation_sensitivity refits with the newest periods removed (up to a quarter of the series). If those move the ratio across 1, the trend rests on a few periods."
    }
  ],
  "warnings": [
    "Restricted to series='Osmotic demyelination syndrome (G37.2), any mention on certificate' (Single series: G37.2 as any mention (multiple cause) on the certificate); 26 of 26 rows.",
    "Restricted to the window 1999-2024 on 'year' as the question asks; 26 of 26 rows retained.",
    "Rates modelled as counts against 'population' as a population offset, so the trend is reported as a rate ratio per period."
  ],
  "environment": {
    "git_sha": "19262990c8f26807254bedcd2cebfff25a5e08b8",
    "git_dirty": false,
    "python": "3.14.3",
    "platform": "Linux-x86_64",
    "packages": {
      "pandas": "3.0.5",
      "numpy": "2.5.2",
      "statsmodels": "0.14.6",
      "scipy": "1.18.0",
      "duckdb": "1.5.5"
    },
    "container_digest": null
  }
}