Mortality and hospital admissions in people with eating disorders. A 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 but necessary to understand clinical needs of this population. Inequalities in these health outcomes across a range of socio-demographic characteristics have rarely been investigated.Aims. We investigated whether people with eating disorders had greater all-cause mortality and physical health-related admissions compared to people without eating disorders and whether associations varied by sex, ethnicity, deprivation, age, and calendar year at diagnosis.Methods. 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, EDNOS, generic eating disorders, or a referral code) to four people without eating disorders. We used univariable and multivariable Cox (mortality) and Poisson (admissions) models and fitted interactions to investigate whether associations varied by socio-demographic characteristics. Results. We included 58,735 people (90.1% female, 91.6% white). People with eating disorders had higher all-cause mortality (Hazard Ratio[HR]: 2.15, 95% confidence interval [CI]: 1.73 – 2.67). Anorexia nervosa had the highest mortality (HR: 3.49, 95%CI: 2.43 – 5.01). People with any eating disorders had higher rates of planned (Incidence Rate Ratio[IRR]: 1.44, 95%CI: 1.40 – 1.47), emergency (IRR: 1.67. 95%CI: 1.62 – 1.72) and emergency admissions for injuries, accidents and substance misuse (IRR: 2.18, 95%CI: 2.06 – 2.31). Mortality rate ratios were greater in males, and admission rate ratios in males, older people, and people living in affluent areas of England. Conclusions. People with eating disorders have high rates of mortality and admissions. We observed inequalities in outcomes across specific socio-demographic groups, calling 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.