Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis

Abstract

Background: Anorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases. However, few studies have examined inpatient characteristics and treatment for AN. This study aimed to characterise the association between mortality and risk factors in patients with AN in acute-care hospitals. Methods: We conducted a nationwide, retrospective analysis of the Japanese Diagnosis and Procedure Combination inpatient database. Data extraction occurred from April 2010 to March 2016. We estimated in-hospital mortality and identified independent risk factors, using multivariate logistic regression analysis to examine patient characteristics and physical and psychological comorbidities. Results: We identified 6937 patients with AN aged ≥12 years in 885 acute-care hospitals. Of these, 361 (5.2%) were male. Male and female participants' median ages at first admission were 34 (17-65) and 28 (17-41) years, respectively. In total, 195 in-hospital patient deaths, including 22 (6.1%) men and 173 (2.6%) women, it was observed that the unadjusted odds ratio of mortality for male patients was more than twice that for female patients (OR: 2.40, 95% CI: 1.45-3.81). Multivariate logistic regression analysis demonstrated an adjusted odds ratio of 2.19 (95% CI: 1.29-3.73). Age at first hospital admission, percentage of ideal body weight, comorbidities, and hypotension were significantly associated with increased mortality risk, but the frequency of hospitalization, bradycardia, and other psychiatric disorders were not. Treatment in a university hospital was associated with lower mortality risk (odds ratio: 0.45, 95% CI: 0.30-0.67). Conclusion: The results highlighted sex differences in mortality rates. Potential risk factors could contribute to improved treatment and outcomes. These retrospective findings indicate a need for further longitudinal examination of these patients.

Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a medical unit

“…These lower SMRs in studies analyzing the mortality of patients with AN after hospitalization in psychiatric department may be explained by the fact that patients with AN hospitalized in these studies tend to be less severely malnourished and less clinically compromised than patients with AN hospitalized in our unit. Thus, mean BMI on admission was higher in these studies compared to our cohort: 14.5 kg/m 2 in the study published by Huas et al, 14 between 10.5 and 17.5 kg/m 2 in the study published by Rosling et al, 19 13.9 kg/m 2 for the deceased group in the study published by Fichter et al 14 And a lower BMI has been associated with a higher mortality in the literature 8,19,25,28 …”

“…However, mortality is even higher in tertiary care centers that treat the most severe forms of the disorder: SMR at 10.6 among adult inpatients in tertiary ED center 7 . Mortality rates in AN adults after an inpatient treatment have been largely studied 7‐33 . However, the results vary widely depending on the characteristics of the cohort studied (size, outpatient or inpatient, medical or psychiatric department, severity of malnutrition, duration of ED, duration of follow‐up), and on the methodology used.…”

“…Thus, mean BMI on admission was higher in these studies compared to our cohort: 14.5 kg/m 2 in the study published by Huas et al, 14 between 10.5 and 17.5 kg/ m 2 in the study published by Rosling et al, 19 13.9 kg/m 2 for the deceased group in the study published by Fichter et al 14 And a lower BMI has been associated with a higher mortality in the literature. 8,19,25,28 The higher SMR found in our cohort could also be explained by a particular profile of patients more chronically ill, with an older age and a longer duration of ED, compared to the literature data: mean age at admission was 26.4, 26.8, 25 and 19.4 years old, respectively in the study by Huas et al, 7 Rosling et al, 19 Fichter et al, 14 Papadopoulos et al 20 Mean duration of AN was respectively in these last studies 8.4 (7), 7 (19), 7.1 years (14). And a longer duration of ED has been associated with a higher mortality in the literature.…”

The changing profile of eating disorders and related sociocultural factors in Japan between 1700 and 2020: A systematic scoping review

“…During this time period, there have been a few studies that have examined ED presentations among males. Among clinical ED samples, approximately 2.1–5.2% of patients are estimated to be males (Edakubo & Fushimi, 2020; Harada et al, 2016; Nakai et al, 2001; Nakai et al, 2018). While researchers have not identified any significant differences in clinical features between male and female patients with AN (Harada et al, 2016), male patients have a higher mortality rate than their female counterparts.…”

“…While researchers have not identified any significant differences in clinical features between male and female patients with AN (Harada et al, 2016), male patients have a higher mortality rate than their female counterparts. For instance, Edakubo and Fushimi (2020) assessed a mixed‐gender sample of patients with AN in acute hospital settings, and found that the adjusted odds ratio of mortality for male patients was two times greater than female patients with AN.…”