title: Impact of urbanization on detection rates of eating disorders.
abstract: OBJECTIVE
  The purpose of this study was to examine the incidence of anorexia nervosa and bulimia nervosa among patients in primary care and to evaluate the impact of urbanization, age and sex differences, and changes over time.
  
  
  METHODS
  During 1985-1989, 58 general practitioners, trained in diagnosing eating disorders, registered all of their patients who had diagnoses of anorexia nervosa and/or bulimia nervosa according to strict criteria. The study population (N = 151,781) was 1% of the population of the Netherlands; the distribution of sexes, ages, geographical locations, and degrees of urbanization in the study group was representative of the Dutch population. Main outcome measures were rates of newly detected cases and age-adjusted rate ratios.
  
  
  RESULTS
  The crude annual incidence rate of detected cases in primary care per 100,000 person-years was 8.1 for anorexia nervosa and 11.5 for bulimia nervosa. The incidence of bulimia nervosa was lowest in rural areas, intermediate in urbanized areas, and highest in large cities (6.6, 19.9, and 37.9, respectively, per 100,000 females per year); no rural-urban differences for anorexia nervosa were found. Pronounced sex and age differences in incidence rates were observed. Over the 5-year period, there was no time trend in the incidence of anorexia nervosa, but the incidence of bulimia nervosa tended to increase.
  
  
  CONCLUSIONS
  The incidence rates of eating disorders--as defined by detection rates in primary care--are higher than previously reported. Urbanization seems to be a risk factor for bulimia nervosa but not for anorexia nervosa.
authors.affiliation: Department of Psychiatry, University Hospital Utrecht, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Hoek
authors.forename: A I
authors.initials: AI
authors.lastname: Bartelds
authors.forename: J J
authors.initials: JJ
authors.lastname: Bosveld
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: V E
authors.initials: VE
authors.lastname: Limpens
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
authors.forename: C J
authors.initials: CJ
authors.lastname: Spaaij
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology; D001835:Body Weight; D002032:Bulimia / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014507:Urbanization