Mortality and hospital admissions in people with eating disorders: longitudinal cohort study in secondary care-linked English primary care records

Background

Research on mortality and admissions for physical health problems across eating disorder diagnoses in representative settings is scarce. Inequalities in these outcomes across a range of sociodemographic characteristics have rarely been investigated.

Aims

We investigated whether people with eating disorders had greater all-cause mortality and physical health-related in-patient admissions compared with those without eating disorders, and whether associations varied by sex, ethnicity, deprivation, age and calendar year at diagnosis.

Method

Using primary care Clinical Research Practice Datalink linked to Hospital Episode Statistics, we matched people with an incident eating disorder diagnosis (any, anorexia nervosa, bulimia nervosa, eating disorders not otherwise specified, generic eating disorder or a referral code) from primary care Read codes to four people without eating disorders (1:4 matching) on year of birth, sex, primary care practice, year of registration and index date. We used univariable and multivariable Cox (mortality) and Poisson (admissions) models, and fitted interactions to investigate whether associations varied by sociodemographic characteristics.

Results

We included 58 735 people (90.1% female, 91.6% White). People with any eating disorders had higher all-cause mortality (hazard ratio: 2.15, 95% CI: 1.73–2.67). Anorexia nervosa had the highest mortality (hazard ratio: 3.49, 95% CI: 2.43–5.01). People with any eating disorders had higher rates of planned (incidence rate ratio (IRR): 1.80, 95% CI: 1.4–1.87) and emergency admissions for physical health problems (IRR: 2.35. 95% CI: 2.35–2.46) and emergency admissions for injuries, accidents and substance misuse (IRR: 5.26, 95% CI: 5.24–5.29). Mortality and admission rate ratios were greater in males.

Conclusions

People with eating disorders have high rates of mortality and physical health-related admissions. Observed inequalities call for an understanding of why such inequalities exist. These findings highlight the need for prompt and effective treatment for eating disorders, and for improved guidance on primary care management of people with eating disorders.