Mortality in anorexia nervosa and bulimia nervosa: A population-based cohort study in Taiwan, 2002-2017

Mei-Chih Meg Tseng; Li-Nien Chien; Chao-Ying Tu; Hung-Yi Liu

doi:10.1002/eat.23934

Mortality in anorexia nervosa and bulimia nervosa: A population-based cohort study in Taiwan, 2002-2017

Int J Eat Disord. 2023 Jun;56(6):1135-1144. doi: 10.1002/eat.23934. Epub 2023 Mar 14.

Authors

Mei-Chih Meg Tseng^{1

2

3}, Li-Nien Chien^{4

5}, Chao-Ying Tu^{3

6}, Hung-Yi Liu⁵

Affiliations

¹ Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³ Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.
⁶ Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.

PMID: 36916458
DOI: 10.1002/eat.23934

Abstract

Objective: To investigate natural- and unnatural-cause mortality at different follow-up time points in Taiwanese patients with anorexia nervosa (AN) and bulimia nervosa (BN).

Method: In this longitudinal cohort study, 330,393 patients, including 2143 patients with AN, 13,590 with BN, and 20 times as many respective non-AN and non-BN patients, were followed up for 16 years. We performed conditional Cox regression survival analysis to examine the risk of mortality in the AN and BN groups relative to the comparison group.

Results: A total of 1242 patients died, including 101 and 343 patients with AN and BN, respectively. Mortality rates for AN and BN were 5.42 and 2.90 deaths per 1000 person-years, respectively. Compared with the non-AN group, the AN group had a significantly higher risk of both natural- and unnatural-cause mortality, and the BN group had a significantly higher risk of unnatural-cause mortality. Suicide was the most common cause of death, and suicide risk was significantly higher in both the AN and BN groups. All-cause mortality risk was the highest at the beginning of follow-up and markedly declined in the AN group. In the BN group, all-cause mortality risk was lower but stable at follow-up. The risk of unnatural-cause mortality remained high throughout the follow-up period for both the groups.

Conclusions: Early detection and treatment for associated physical problems in patients with AN are crucial. Regular monitoring for unnatural-cause mortality events (mainly suicide) in AN and BN over time is also crucial.

Public significance: AN had a significantly higher risk of both natural- and unnatural-cause mortality and BN had a significantly higher risk of death from unnatural causes. All-cause mortality risk was highest at the beginning of follow-up in AN, but unnatural-cause mortality risk remained high throughout the follow-up period for both groups. Our findings imply that early detection and treatment in AN and regular monitoring for unnatural-cause mortality events in AN and BN are crucial.

Keywords: all-cause mortality; anorexia nervosa; bulimia nervosa; cumulative incidence of mortality; natural-cause mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anorexia Nervosa* / complications
Bulimia Nervosa* / therapy
Cohort Studies
Humans
Longitudinal Studies
Taiwan / epidemiology