Social Disparity and Treatment-Seeking in Eating Disorders During Childhood and Adolescence: A Nationwide Population-Based Cohort Study
Abstract
Objective: Advantaged socioeconomic circumstances are linked to a higher risk of diagnosed eating disorders (EDs). However, evidence on non-diagnosed cases, that is, individuals reporting ED symptoms without formal diagnosis, remains limited, suggesting detection and treatment-seeking barriers. In this study, we assessed associations between socioeconomic circumstances and clinically diagnosed and non-diagnosed EDs in childhood and adolescence.
Method: This study used data from the Danish National Birth Cohort, linking registry-based diagnosed EDs (participant ages 6-18 years) with self-reported ED symptoms at age 18 years. Data included 523,148 individuals born in Denmark between 1996 and 2003, with 44,552 providing information on self-reported ED symptoms used to classify non-diagnosed EDs. Socioeconomic indicators, including parental education and household income at age 6 years, were analyzed using quasi-Poisson and multinomial logistic regression to estimate incidence rate ratios (IRRs) and relative risk ratios (RRRs).
Results: Diagnosed EDs were more common among individuals with higher parental education, following a stepwise pattern. Compared to short education (∼12 years), long education (∼17-20 years) was associated with higher risk (IRR = 1.35, 95% CI = 1.21-1.52), whereas basic education (∼10 years) was linked to lower risk (IRR = 0.70, 95% CI = 0.59-0.83). The pattern reversed for non-diagnosed EDs, with individuals whose parents had basic education showing a…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 523,148 participants or records.
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