A diagnostic subgroup comparison of health care utilization patterns in individuals with eating disorders diagnosed in childhood and/or adolescence

Abstract

ObjectiveThis study examined a 2‐year period after diagnosis of an eating disorder to compare health care utilization in diagnostic subgroups including: anorexia nervosa (AN), bulimia nervosa (BN), binge‐eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified eating disorders (Other).MethodWe conducted a retrospective study of children diagnosed with AN (n = 674), BN (n = 230), BED (n = 59), ARFID (n = 171), and Other (n = 315). We used a general population cohort for comparison, matched 5:1 to the diagnostic subgroups on sex and birth date. We then conducted a separate analysis using the ARFID subgroup as a reference group compared to the other subgroups. Outcomes were determined using data linkage with health administrative databases and included hospitalizations, emergency department, general practitioner, psychiatry, and pediatrician visits. Odds ratios (dichotomous outcomes) and rate ratios (continuous outcome) were calculated.ResultsMental health care utilization was higher for all subgroups compared to the general population. When the subgroups were compared to the ARFID subgroup, those with ARFID appeared to have similar health care utilization to the other subgroups, except when compared to those with AN. The AN subgroup had higher odds of a mental health related hospitalization (OR 1.62, 95% CI 1.04–2.5) higher rates of mental health related pediatrician visits (RR 1.76, 95% CI 1.26–2.46) and psychiatry visits (RR 1.69, 95% CI 1.07–2.68).ConclusionsThose with ARFID have similar utilization as other subtypes of eating disorders, except when compared to those with AN who have higher health care utilization.Public SignificanceOur study found that the health service needs of young people with all types of eating disorders are substantially higher than the general population, and it appears that Avoidant/Restrictive Food Intake Disorder (ARFID) has similar health care utilization to other eating disorders.

Eating disorder hospitalizations among children and youth in Canada from 2010 to 2022: a population-based surveillance study using administrative data

“…Some research confirms this finding [ 11 , 15 ], whereas other studies report no clear sex-differences of age of onset [ 7 , 31 ]. Additionally, males are more frequently diagnosed with ARFID, which is an ED that is typically diagnosed earlier than AN or BN, [ 29 – 33 ] which may explain the younger age of hospitalization among males in our study.…”

“…The distribution of ED diagnoses was similar between males and females in our study, however, males had a higher proportion of other EDs compared to females. This difference may be due to males not meeting the diagnostic criteria or having different clinical presentations for EDs, and therefore are being captured in the other ED category [ 9 , 29 , 30 ].Additionally, males are more likely than females to present with ARFID [ 29 – 33 ], which falls into our category of other EDs.…”

Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms

“…While ARFID can occur across the lifespan, it is more prevalent in younger children, which is in contrast to other eating disorders which occur more frequently later in adolescence [6]. As a consequence of higher childhood prevalence rates, previous research about health behavior (e.g., physical activity) and treatment utilization focuses predominantly on children and adolescents [7][8][9]. Thus, more research into adult samples is needed.…”

“…Children and adults with eating disorders in general exhibit high utilization of mental healthcare services [10,11]. They utilize health care services more frequently than matched healthy individuals with similar rates across different diagnoses [9,10]. In ARFID, research about treatment utilization is comparably scarce.…”

“…Furthermore, the heterogenous presentation of ARFID and the high need for multidisciplinary treatments raises difficulties for treatment centers to correctly diagnose and adopt treatments to the specific needs of patients with ARFID [1]. Limited research on psychiatric and psychotherapy utilization in ARFID has demonstrated comparable treatment utilization in children with ARFID versus other eating disorders [9]. In adults, there is some evidence that readmission rates for ARFID are lower than those for other eating disorders, but overall psychological treatment utilization in adults is unclear [12].…”