Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies | Psychiatry and Behavioral Health | JAMA Psychiatry | JAMA Network
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July 2011

Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies

Author Affiliations

Author Affiliations: Loughborough University Centre for Research into Eating Disorders, Loughborough University (Dr Arcelus), Brandon Unit, Eating Disorders Service (Dr Arcelus and Ms Wales), and Department of Psycho-Oncology (Dr Mitchell), Leicester Partnership Trust, Leicester General Hospital, and Department of Cancer and Molecular Medicine, Leicester Royal Infirmary, University of Leicester (Dr Mitchell), Leicester, England; and Region Sjælland, Child and Adolescent Psychiatric Services, Næstved, Denmark (Dr Nielsen).

Arch Gen Psychiatry. 2011;68(7):724-731. doi:10.1001/archgenpsychiatry.2011.74

Context  Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified.

Objective  To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).

Data Sources  A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience).

Study Selection  English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders.

Data Extraction  Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis.

Data Synthesis  From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide.

Conclusions  Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.