Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada
Acute presentations of eating disorders among adolescents and ... CMAJ
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Abstract
Background:
Background: Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.
Methods
Study design and population
We conducted a population-based, repeated cross-sectional study of all people aged 10–105 years living in Ontario, Canada, who were eligible for provincial health insurance. We used linked health administrative databases housed at ICES, an independent, nonprofit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. We identified all emergency department visits and hospital admissions related to an eating disorder before (Jan. 1, 2017, to Feb. 29, 2020) and during (Mar. 1, 2020, to Aug. 31, 2022) the COVID-19 pandemic. We determined monthly rates of eating disorder emergency department visits and admissions by age group, including adolescents (10–17 yr), young adults (18–26 yr), adults (27–40 yr), and older adults (41–105 yr). We excluded non-Ontario residents, people with invalid birth dates and deaths within the study period, and those with missing data on sex. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
Data sources
We accessed data from several databases and linked them using unique ICES encoded identifiers. We identified the study population through the Registered Person’s Database, a registry of all people eligible for Ontario’s publicly funded health care through the Ontario Health Insurance Plan, and used this database to capture sociodemographic variables including date of birth, sex, and postal code. The Ontario Marginalization Index for neighbourhood material deprivation combines Census information on income and education and was used as a measure of socioeconomic status. Quintiles are used to define the marginalization index, with 1 representing the least deprived and 5 representing the most deprived neighbourhoods. We determined urban or rural region of residence by the Rurality Index of Ontario score, which is a continuous and broader measure of rurality used for policy development purposes in Ontario based on census subdivision, linked with postal codes in the Statistics Canada Postal Code Conversion File to Canadian Census data. Rurality scores are on a 100-point scale, with rural residence defined as a score of 40 or higher. We identified emergency department visits using the National Ambulatory Care Reporting System, and hospital admissions from the Canadian Institute for Health Information’s Discharge Abstract Database and the Ontario Mental Health Reporting System.
Measures
We identified visits related to an eating disorder during the study period using diagnostic coding from the 9th and 10th revisions of the International Classification of Diseases and Related Health Problems and included visits with any eating disorder–related diagnostic code, unless the eating disorder did not contribute to the stay (Appendix 1, Supplemental eTable 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.221318/tab-related-content). These diagnostic codes have been shown to have high specificity for presentations of eating disorders, and previous analyses have shown that separating those who are admitted to hospital for an eating disorder and those who attend the emergency department for an eating disorder results in distinct, clinically relevant populations.16 Individual eating disorders included anorexia nervosa, bulimia nervosa, other eating disorders, and provisionally diagnosed eating disorders (Appendix 1, eTable 1). We quantified monthly rates of eating disorder–related emergency department visits and hospital admissions per 100,000 population during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic periods (Mar. 1, 2020, to Aug. 31, 2022).
We ascertained sociodemographic and clinical characteristics of the population as of January 1 of each study year and included age, sex, rurality, neighbourhood-level material deprivation quintile, pre-existing mental health condition (i.e., any outpatient or acute claim with a mental health–related concern within 2 yr), and history of eating disorder–related visit (i.e., any acute claim with a relevant eating disorder diagnostic code within 2 years and lifetime lookback to 2002), using similar definitions as the primary outcome (Appendix 1, Supplemental eTable 1). Among people with an eating disorder–related emergency department visit or hospital admission, we reported the health care setting (i.e., community hospital, adult academic hospital, or pediatric hospital).
Statistical analysis
We calculated monthly rates of outpatient mental health visits per 100,000 people in the Ontario study population in each study year. We used Poisson generalized estimating equations models for clustered count data to model the prepandemic trends and to predict expected rates of eating disorder–related emergency department visits and hospital admissions in the pandemic period in the absence of restrictions. The unit
SDGs, Targets, and Indicators
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 5: Gender Equality
2. What specific targets under those SDGs can be identified based on the article’s content?
- SDG 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
- SDG 5.5: Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic, and public life.
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Emergency department visits and hospital admissions for eating disorders among different age groups.
- Incidence rate ratios (IRRs) comparing rates during the pandemic to expected rates derived from the prepandemic period.
Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. | Emergency department visits and hospital admissions for eating disorders among different age groups. |
| SDG 5: Gender Equality | Target 5.5: Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic, and public life. | Emergency department visits and hospital admissions for eating disorders among females. |
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Source: cmaj.ca
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