Mortality in anorexia nervosa and bulimia nervosa: A population-based cohort study in Taiwan, 2002-2017.

OBJECTIVE To investigate natural- and unnatural-cause mortality at different follow-up time points in Taiwanese patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD In this longitudinal cohort study, 330,393 patients, including 2143 patients with AN, 13,590 with BN, and 20 times as many respective non-AN and non-BN patients, were followed up for 16 years. We performed conditional Cox regression survival analysis to examine the risk of mortality in the AN and BN groups relative to the comparison group. RESULTS A total of 1242 patients died, including 101 and 343 patients with AN and BN, respectively. Mortality rates for AN and BN were 5.42 and 2.90 deaths per 1000 person-years, respectively. Compared with the non-AN group, the AN group had a significantly higher risk of both natural- and unnatural-cause mortality, and the BN group had a significantly higher risk of unnatural-cause mortality. Suicide was the most common cause of death, and suicide risk was significantly higher in both the AN and BN groups. All-cause mortality risk was the highest at the beginning of follow-up and markedly declined in the AN group. In the BN group, all-cause mortality risk was lower but stable at follow-up. The risk of unnatural-cause mortality remained high throughout the follow-up period for both the groups. CONCLUSIONS Early detection and treatment for associated physical problems in patients with AN are crucial. Regular monitoring for unnatural-cause mortality events (mainly suicide) in AN and BN over time is also crucial. PUBLIC SIGNIFICANCE AN had a significantly higher risk of both natural- and unnatural-cause mortality and BN had a significantly higher risk of death from unnatural causes. All-cause mortality risk was highest at the beginning of follow-up in AN, but unnatural-cause mortality risk remained high throughout the follow-up period for both groups. Our findings imply that early detection and treatment in AN and regular monitoring for unnatural-cause mortality events in AN and BN are crucial.

[1]  H. Steiger,et al.  Anorexia nervosa and the long‐term risk of mortality in women , 2021, World psychiatry : official journal of the World Psychiatric Association.

[2]  P. Kurdyak,et al.  Excess mortality associated with eating disorders: population-based cohort study , 2020, The British Journal of Psychiatry.

[3]  M. Benadjaoud,et al.  Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a medical unit , 2020, Acta psychiatrica Scandinavica.

[4]  M. Tseng,et al.  Paths to the first-time diagnoses of anorexia nervosa and bulimia nervosa in Taiwan. , 2020, The International journal of eating disorders.

[5]  U. Voderholzer,et al.  Mortality in males as compared to females treated for an eating disorder: a large prospective controlled study , 2020, Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity.

[6]  K. Fushimi,et al.  Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis , 2020, BMC psychiatry.

[7]  Joanne C. Demmler,et al.  Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study , 2019, The British Journal of Psychiatry.

[8]  M. Hotopf,et al.  Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa , 2019, Social Psychiatry and Psychiatric Epidemiology.

[9]  Chelsea T. A. Doktorchik,et al.  Validation of a case definition for depression in administrative data against primary chart data as a reference standard , 2019, BMC Psychiatry.

[10]  N. Auger,et al.  Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women. , 2019, JAMA psychiatry.

[11]  Hong-Jie Dai,et al.  Using text mining to extract depressive symptoms and to validate the diagnosis of major depressive disorder from electronic health records. , 2019, Journal of affective disorders.

[12]  H. Pope,et al.  Evolving Perspectives on the Public Health Burden of Eating Disorders , 2018, Biological Psychiatry.

[13]  M. Hotopf,et al.  Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa , 2018, European Archives of Psychiatry and Clinical Neuroscience.

[14]  M. Fichter,et al.  Mortality in eating disorders - results of a large prospective clinical longitudinal study. , 2016, The International journal of eating disorders.

[15]  Tsung-Mei Cheng Reflections on the 20th anniversary of Taiwan's single-payer National Health Insurance System. , 2015, Health affairs.

[16]  A. Ghaderi,et al.  Mortality in anorexia nervosa – a look back at and beyond one of the most cited papers in the field , 2015 .

[17]  D. Franko,et al.  Re-examining premature mortality in anorexia nervosa: a meta-analysis redux. , 2014, Comprehensive psychiatry.

[18]  Seena Fazel,et al.  Risks of all‐cause and suicide mortality in mental disorders: a meta‐review , 2014, World psychiatry : official journal of the World Psychiatric Association.

[19]  J. Suvisaari,et al.  Mortality in eating disorders: A follow-up study of adult eating disorder patients treated in tertiary care, 1995–2010 , 2013, Psychiatry Research.

[20]  Kamryn T. Eddy,et al.  A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. , 2013, The American journal of psychiatry.

[21]  D. Stockton,et al.  Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986–2010 , 2013, BMJ Open.

[22]  I. Brandão,et al.  Anorexia nervosa and dialysis: we have no time when the body is so damaged! , 2013, BMJ Case Reports.

[23]  J. Guelfi,et al.  Mortality and its predictors in severe bulimia nervosa patients. , 2013, European eating disorders review : the journal of the Eating Disorders Association.

[24]  Rafael Lozano,et al.  Modeling causes of death: an integrated approach using CODEm , 2012, Population Health Metrics.

[25]  A. Mitchell,et al.  Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. , 2011, Archives of general psychiatry.

[26]  A. Preti,et al.  A comprehensive meta‐analysis of the risk of suicide in eating disorders , 2011, Acta psychiatrica Scandinavica.

[27]  S. Crow,et al.  Increased mortality in bulimia nervosa and other eating disorders. , 2009, The American journal of psychiatry.

[28]  P. Austin Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples , 2009, Statistics in medicine.

[29]  L. Ekselius,et al.  Excess mortality, causes of death and prognostic factors in anorexia nervosa , 2009, British Journal of Psychiatry.

[30]  P. Chou,et al.  Suicides after the 1999 Taiwan earthquake. , 2003, International journal of epidemiology.

[31]  T. Lu,et al.  Comparison of official coders versus physician panel in assignment of underlying cause of death. , 2001, Journal of the Formosan Medical Association = Taiwan yi zhi.

[32]  C. Emborg,et al.  Mortality and causes of death in eating disorders in Denmark 1970-1993: a case register study. , 1999, The International journal of eating disorders.

[33]  B. Barraclough,et al.  Excess mortality of mental disorder , 1998, British Journal of Psychiatry.

[34]  S. Theander,et al.  Standardized mortality in eating disorders--a quantitative summary of previously published and new evidence. , 1998, Journal of psychosomatic research.

[35]  S. Nielsen,et al.  Mortality in anorexia nervosa in Denmark during the period 1970‐1987 , 1996, Acta psychiatrica Scandinavica.