A new report from Health Affairs examined federal data on healthcare spending to rank the 10 costliest conditions in the U.S. Tops on the list: Mental health accounted for $201 billion in 2013. Heart conditions came in next at $147 billion, with trauma rounding out the top three at $143 billion.

The study, written by Charles Roehrig of the Center for Sustainable Health Spending at Altarum Institute in Ann Arbor, Michigan, updated a 2009 report that estimated health expenditures by medical condition through 2013.

Spending rates on heart problems and strokes grew at a rate lower than overall spending, which the report attributes to decreased smoking and other improved lifestyle changes. But the positives in those areas of care partly attribute to the growth in spending on mental disorders.

“A look ahead suggests that reductions in deaths from heart conditions and cerebrovascular disease are likely to drive spending on mental disorders even higher, as more people survive to older ages—when mental disorders, such as dementia, become more prevalent,” Roehrig wrote.

More than 40 percent of the $201 billion in mental health spending went to institutionalized individuals, a consideration the report claims other studies frequently overlook.