Eating Disorders Rose Over Decade, Down Recently


Despite a 24% increase in the decade between 1999 and 2009, hospitalizations for a principal or secondary diagnosis of an eating disorder have declined in recent years, according to a statistical brief from the Healthcare Cost and Utilization Project. The one exception is pica, in which the number of cases nearly doubled during this period.

HCUP, sponsored by the Agency for Healthcare Research and Quality (AHRQ), combines the data of private and government organizations to create a national information resource. In this statistical brief, Yafu Zhao, MS, and William Encinosa, Ph.D., present data on national estimates of hospitalizations for eating disorders during the decade between 1999-2000 and 2008-2009 (HCUP Statistical Brief #120, September 2011). A previous statistical brief looked at hospitalizations for eating disorders between 1999 and 2006, but not much is known about recent trends, the authors say.

The quality of outpatient care for eating disorders may have improved significantly, particularly between 2007 and 2009, to reduce principal diagnosis eating disorder hospitalizations.

Eating disorders, especially anorexia nervosa, have the highest mortality rate of any psychiatric disorders. Patients often require hospitalization to treat secondary disorders, such as severe starvation, cardiac arrhythmia, severe dehydration, gastrointestinal problems, depression, fluid and electrolyte disorders, schizophrenia, or alcohol-related disorders.

In comparing the data between 1999-2000 and 2008-2009, the numbers look bleak. Specifically, 29,533 individuals were hospitalized for an eating disorder in 2008-2009, up 24% from 23,807 in 1999-2000, according to HCUP. Hospitalizations with eating disorder as the principal diagnosis actually declined by 1% during the decade, from 5,689 to 5,587, but hospitalizations with eating disorder as a secondary diagnosis increased 40%, from 17,118 to 23,946.

Between 1999-2000 and 2000-2009, there were significant increases in serious complications in patients with eating disorders. This includes nutritional deficiencies and other nutritional, endocrine, and metabolic disorders, which increased by 129%; acute renal or liver failure, 127%; cardiac dysrhythmias, 103%; menstrual disorders, 62%; deficiency and other anemia, 66%; convulsions/epilepsy, 55%; and fluid and electrolyte disorders, 18%.

Also noteworthy: Hospitalizations for pica, in which patients eat inedible materials such as soil or feces, increased by 93%, Some 31% percent of children who were hospitalized with pica in 2009 had an autism spectrum disorder.

However, a comparison of numbers between 2007-2008 and 2008-2009 offers a better outlook: Hospitalizations declined 4%, from 30,754 cases to 29,533, during this time. Eating disorder as a principal diagnosis declined 23%, from 7,290 cases to 5,587. The number of hospitalizations with eating disorder as a secondary cause did increase slightly, by 482 cases

Between 2007-2008 and 2008-2009, however, there were decreases in serious complications, namely nutritional deficiencies and other nutritional, endocrine, and metabolic disorders, 12%; acute renal or liver failure, 39%; cardiac dysrhythmias, 39%; menstrual disorders, 46%; deficiency and other anemia, 27%; convulsions/epilepsy, 17%; and fluid and electrolyte disorders, 23%. One exception: Hospitalizations for pica increased 5% between 2007-2008 and 2008-2009.

"Overall, the results of this Statistical Brief indicate that the quality of outpatient care for eating disorders may have improved significantly between 1999 and 2009, particularly between 2007 and 2009, in such a way as to reduce principal diagnosis eating disorder hospitalizations," the authors say. "It is doubtful that this is an artifact of the 2009 recession, since secondary diagnosis eating disorder hospitalizations did not decline during the recession."

The HCUP data also provides some demographic data about patients with eating disorders. Specifically, 9 out of 10 patients who have eating disorders are women, eating disorders increased by 53% in men vs. 21% of women between 1999-2000 and 2008-2009 vs. 21% in women.

In 2008-2009, 3% percent of hospital stays involving eating disorders were for children younger than 12. Additional eating-disorder patient stays by age are as follows: 12 to 19 years, 19% of stays; 19 to 30, 28%; 30 to 45, 25%; 45 to 64, 18%; and 65 and older, 7%.

The aggregate costs for any hospital stay involving eating disorders was $277 million, up 68% from $165 million in 1999-2000. The average cost per hospital stay went from $7,300 in 1999-2000 to $9,400 in 2008-2009, a 28.8% increase. The average length of hospital stay was unchanged at 8 days.

The authors reported having no disclosures.

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