Mortality from eating disorders - A 5- to 10-year record linkage study

Purpose: Previous research has found elevated mortality rates from anorexia nerrosa (AN) and perhaps bulimia nervosa (BN). This study was performed using computerized record linkage to examine mortality rates in a cohort of patients with eating disorder (ED) diagnoses seen in an emergency room (ER) by a psychiatry service. Methods: ER records were retrieved for 122 consecutive ED patients seen over a 5-year period from 1985 to 1990. Demographic data, identifiers including social security number and date of birth, and clinical information were recorded; record linkage to a computerized vital status database, MINNDEX, through 1995 was then performed. Death certificates were subsequently obtained and reviewed to identify cause of death. Results: The average age at time of ER visit was 25.7 (SD 7.4); 91.8% were female, 8.2% male. The most common diagnosis was AN (44.3%); 34.4% were diagnosed with BN, and 21.3% with eating disorder not otherwise specified (EDNOS). Five subjects died in the 5 to 10-year follow-up period (all female). One deceased subject carried a diagnosis of BN, the other 4 had AN. Three subjects with AN were listed on death certificates as having died of that illness; the fourth died of emphysema. The deceased subject with BN died of traumatic causes. The crude mortality rates were 7.4% for AN and 2.4% for BN. The standardized mortality ratio for AN was 8.35. Conclusions: This study confirms and extends prior reports of high mortality rates in AN, using an epidemiologic database with high ascertainment rates. While the crude mortality rate for BN was also high, the small sample size makes it difficult to draw conclusions.