Multiple adverse health outcomes among individuals diagnosed with an eating disorder: findings from a large primary care cohort with linked secondary care and mortality records

Problem

Eating disorders are characterised by persistent abnormal and harmful eating behaviours. In a recent Public Health England report (2019), a worrying increase in hospital admissions due to an eating disorder was reported, with half the admissions in 10-19 year olds. Eating disorders impact on both mental and physical health, however, evidence of fatal and non-fatal health risks among individuals diagnosed with eating disorders is limited.

Our aims, therefore, were to examine the risk of adverse mental and physical health outcomes and report all cause and cause-specific mortality risk including natural, unnatural deaths, suicide and fatal poisonings in a large population based matched cohort of incident eating disorder cases.

Approach

Using the Clinical Practice Research Datalink, we examined interlinked data from primary healthcare records, secondary care (Hospital Episode Statistics), and mortality records (Office of National Statistics). Incident eating disorder cases were identified between 1/1/1998-30/11/2018 aged 10-44 years (n=24,709). Cases were matched by age, gender and practice with 20 comparator individuals without a history of eating disorder (n=493,001). First event of adverse mental health outcome, including depression, anxiety disorder, personality disorder, obsessive compulsive disorder, self-harm and adverse physical health, including osteoporosis, fracture, liver disease, renal and heart failure, diabetes were identified from the linked data. Hazard ratios and cumulative incidence for each adverse outcome, including mortality risk at 1,5,10 years following diagnosis were calculated.

Findings

Risks were elevated among eating disorder cases for all physical and mental health outcomes examined. Individuals with an eating disorder diagnosis were 6 times more likely to develop renal failure or liver disease within a year of diagnosis and over 3 times in subsequent years; 9 times more likely to have a self-harm episode in the first year, with the risk remaining high compared to comparators longer term (12% vs 3% risk at 10 years); within 12 months of an eating disorder diagnosis individuals were 5 times more likely to die from an unnatural cause, 14 times more likely to die by suicide or from fatal poisoning; with risk remaining high at 6 times more likely to die by fatal poisoning at 5 or more years following an eating disorder diagnosis.

Consequences

We have shown a high burden of morbidity and mortality risk in people with an eating disorder diagnosis, compared to those without a history of eating disorder, both in short and long-term risk. This risk has highlighted the importance of proactive care by primary care clinicians in the earlier recognition, diagnosis and monitoring of physical and mental health problems and associated risk in people with eating disorders. There is the need for parity and timely access to co-ordinated care through physical and mental health services.