Mortality rates in anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified: new meta-analysis

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The rates of morbidity and mortality in eating disorders are thought to be high, but the exact rates were not known before this meta analysis published in the Archives of General Psychiatry.

The authors set out to systematically compile and analyze the mortality rates in individuals with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS).  They conducted a systematic literature search and selected English language peer reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders.  They found 36 quantitative studies with sufficient data for extraction.

The studies reported outcomes of:

  • Anorexia nervosa during 166 642 person-years
  • Bulimia nervosa during 32 798 person-years
  • EDNOS during 22 644 person-years

The weighted mortality rates (ie, deaths per 1000 person-years) were:

  • 5.1 for anorexia nervosa
  • 1.7 for bulimia nervosa
  • 3.3 for EDNOS

The standardized mortality ratios were:

  • 5.86 for anorexia nervosa
  • 1.93 for bulimia nervosa
  • 1.92 for EDNOS

One in 5 individuals with anorexia nervosa who died had killed themselves.

The authors concluded:

Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with anorexia nervosa. The mortality rates for bulimia nervosa and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with anorexia nervosa. Further research is needed to identify predictors of mortality in patients with bulimia nervosa and EDNOS.

Arcelus, J. Mitchell, AJ. Wales, J. Nielsen, N. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry 2011;68(7):724-731. doi:10.1001/archgenpsychiatry.2011.74 [Abstract]

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