Long-Term Trends in New and Pre-Existing Eating Disorder Acute Presentations Among Adolescents and Young Adults During and After the COVID-19 Pandemic: A Population-Based Cohort Study

To measure rates of emergency department (ED) visits and hospitalizations among adolescents and young adults with new and pre-existing eating disorders 3.5 years after the onset of the COVID-19 pandemic. We conducted a population-based cross-sectional study using linked health administrative data for Ontario residents aged 10-17 years and 18-26 years during the prepandemic (January 1, 2017-February 29, 2020) and postpandemic periods (March 1, 2020-September 30, 2023). We used Poisson generalized estimating equations models to predict expected yearly overall and monthly age-stratified rates of eating disorder-related ED visits and hospitalizations using prepandemic trends among those with a new or pre-existing eating disorder. ED visit rates peaked above expected in 2021 among adolescents with new (adjusted rate ratio [aRR] 2.70, 95% confidence interval [CI; 2.34, 3.11]) and pre-existing eating disorders (aRR 3.38, 95% CI [2.70, 4.23]). Although ED visit rates decreased over time for adolescents, they remained higher than expected in 2023 for both new (aRR 1.37, 95% CI [1.16,1.63]) and pre-existing eating disorders (aRR 1.53, 95% CI [1.17, 2.01]). Hospitalization trends among adolescents mirrored these patterns. Among young adults, ED visit rates for new eating disorders peaked above expected levels in 2021 (aRR 1.21, 95% CI [1.15, 1.27]), whereas the peak for pre-existing eating disorders occurred in 2020 (aRR 1.45, 95% CI [1.22, 1.73]). By 2022, ED visit rates had returned to or dropped below expected levels. The surge in eating disorder-related acute care visits was limited to the pandemic, with rates mostly returning to baseline, although adolescent rates remain elevated. This highlights the need for continual monitoring of long-term trends to ensure that public health responses are informed by sustained data.