Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 21727255 · doi:10.1001/archgenpsychiatry.2011.74
What was done
A systematic literature search and random-effects meta-analysis (DerSimonian-Laird model) of English-language studies published between 1966 and 2010 evaluated mortality rates and standardized mortality ratios (SMRs) in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), adjusted for person-years of observation.
What was found
From 36 quantitative studies, total observation time was 166,642 person-years for AN, 32,798 person-years for BN, and 22,644 person-years for EDNOS. Weighted mortality rates per 1,000 person-years were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. SMRs 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. Age at assessment was a significant predictor of mortality for AN.
Why it matters
This meta-analysis provides precise benchmark mortality figures across eating disorder diagnoses, confirming an almost six-fold increase in mortality for anorexia nervosa and highlighting suicide as a major contributor to deaths.
Limits
The analysis included only English-language peer-reviewed studies. Because the underlying data are observational, confounding factors, varied follow-up lengths, and evolving diagnostic criteria across decades cannot be ruled out. Predictors of mortality could not be identified for BN and EDNOS from the available data.