All‐cause and cause‐specific mortality risk in individuals with eating disorders: systematic review and meta‐analysis of relative risk and aggravating or attenuating factors
Abstract
Previous meta‐analyses estimating mortality risk in eating disorders (EDs) were restricted to specific disorders or causes of death, and were published before the release of the DSM‐5, which introduced significant changes in ED classification. We conducted a PRISMA 2020‐compliant systematic review and random‐effects meta‐analysis assessing all‐cause (primary outcome) and cause‐specific mortality risk ratio (RR) in cohort/case‐control studies of individuals with EDs versus the general population or groups matched by physical and/or psychiatric comorbidities. Meta‐regression/subgroup analyses assessed risk aggravating or attenuating factors. Study quality was evaluated using design‐specific US National Institutes of Health tools. Altogether, 83 studies were meta‐analyzed (patients with EDs: N=307,710, general population controls: N=15,719,076; mean follow‐up: 11.96 years, females: 94.35%, mean age: 25.52 years). The quality was rated as “good” in 65.0%, “fair” in 21.7%, and “poor” in 13.3% of the studies. Any ED was associated with higher all‐cause mortality vs. the general population (RR=4.92, 95% CI: 4.03‐6.00, ranging from RR=5.52, 95% CI: 4.47‐6.82 in anorexia nervosa (AN) to non‐significant difference in binge eating disorder), as well as with higher suicide‐related mortality (RR=8.45, 95% CI: 5.73‐12.47, ranging from RR=9.86, 95% CI: 5.63‐17.27 in AN to RR=6.15, 95% CI: 2.52‐15.04 in bulimia nervosa). Mortality risk from both natural and non‐natural causes was also…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 15,719,076 participants or records.
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