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Letters to the Editor
August 2003

Standardized Mortality Ratio in Bulimia Nervosa

Arch Gen Psychiatry. 2003;60(8):851. doi:10.1001/archpsyc.60.8.851

I congratulate the authors on a very fine and much needed study on mortality in eating disorders.1 I have but one comment. In the "Comment" section, the authors state, "To our knowledge, only one other study has reported an SMR [standardized mortality ratio] for bulimia nervosa." When submitted for publication (November 13, 2001), information from 2 overviews on this topic2,3 should have been available to the authors. One article was published in March/April 1998,2 and the other in June 2001.3 I have updated the findings on SMR in bulimia nervosa in Table 1. A simulation exercise based on the observation of a linear relationship between expected mortality and person-years surveyed in the 6 studies in the Table 1, encompassing 43 follow-up studies of bulimia nervosa cohorts, gave an overall aggregate (pseudo) SMR of 1.6 (95% confidence interval, 0.8-2.7; P =.15). Of note is that the 6 studies reporting SMR differed significantly from the 37 other follow-up studies (Zelen exact, P =.002).10 These 37 studies had an overall (pseudo) SMR of 0.8 (95% confidence interval, 0.25-1.8; P = .73).

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