Background: Eating disorders are associated with substantial morbidity and mortality that can be minimized by timely access to evidence-based treatment. However, disparate access to eating disorders treatment may contribute to significant health disparities amongst marginalized groups. This study examined the association between insurance type (public vs. private) and receipt of recommended mental health treatment in a sample of racially/ethnically diverse youth who presented to an adolescent medicine clinic with malnutrition secondary to disordered eating.
Methods: A retrospective chart review was conducted for youth ages 11-25 years (N = 1060) who presented to an urban adolescent medicine specialty program between June 1, 2012 and December 31, 2019 for malnutrition secondary to disordered eating. Bivariate and logistic regression analyses examined the association between insurance type (public vs. private) and other demographic/clinical factors on receipt of recommended treatment within six months of the initial evaluation.
Results: Patients with public insurance were one third as likely to receive recommended treatment as patients with private insurance (AOR = 3.23; 95% CI = 1.99, 4.52), after adjusting for demographic and clinical factors. Latinx (AOR = 0.49; 95% CI = 0.31, 0.77) and Asian (AOR = 0.55; 95% CI = 0.32, 0.94) patients were half as likely to receive recommended treatment as White patients.
Conclusions: Access to evidence-based mental health treatment is a necessary first step towards health equity for individuals with eating disorders. Additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color and those with public insurance.
Keywords: Anorexia nervosa (AN); Atypical anorexia nervosa (AAN); Binge eating disorder (BED); Bulimia nervosa (BN); Cognitive behavioral therapy (CBT); County rurality; Family-based treatment (FBT); Hospitalization; Public insurance; Structural racism.
Early management of eating disorders, including mental health and medical treatment, improves outcomes and reduces the likelihood of significant complications including death. However, access to specialized mental health treatment can be challenging, particularly for patients from marginalized identities. This study examined how insurance type affects access to recommended mental health treatment for patients with eating disorders. It included a sample of 1060 youth of diverse racial/ethnic backgrounds who presented to an adolescent medicine clinic with malnutrition secondary to disordered eating. In our sample, youth with public insurance were one third as likely to receive appropriate treatment as youth with private insurance. Additionally, Latinx and Asian patients were half as likely to receive appropriate treatment as White youth. These findings highlight the importance of not only improving access to mental health care for patients with eating disorders, but also addressing the systemic causes of disparities in care for youth of color and those with public insurance.
© 2023. The Author(s).