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Excess mortality associated with eating disorders: population-based cohort study

Published online by Cambridge University Press:  29 October 2020

Tomisin Iwajomo
Affiliation:
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto, Ontario, Canada
Susan J. Bondy
Affiliation:
ICES, Toronto; and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
Claire de Oliveira
Affiliation:
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario; Canada
Patricia Colton
Affiliation:
University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
Kathryn Trottier
Affiliation:
University Health Network, Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
Paul Kurdyak
Affiliation:
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto; and ICES, Toronto; and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto; and Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
Corresponding
E-mail address:

Abstract

Background

Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa.

Aims

To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada.

Method

We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk.

Results

The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82–5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58–7.96) relative to females (SMR = 4.59; 95% CI 4.34–4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population.

Conclusions

Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.

Type
Paper
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

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