Anorexia nervosa mortality in Northeast Scotland, 1965-1999.
OBJECTIVE
Most previous studies of mortality in anorexia nervosa patients have shown an increased risk of premature death but have been limited by methodological constraints. This study aimed to overcome some of these constraints by having a large original sample size, diagnosis confirmed by case note review, a long duration of follow-up, and a clear base population.


METHODS
The authors identified 524 anorexia nervosa cases seen in specialist services in Northeast Scotland; anorexia nervosa diagnosis was confirmed by scrutinizing case notes. Those who had died were identified from the National Health Service register or register of deaths. The death rates and causes of death were analyzed.


RESULTS
Twenty-three patients died, giving a crude death rate of 4.4% and a standardized mortality rate of 3.3 (95% CI=2.2-4.9). In only one-third of the cases was anorexia nervosa on the death certificate, but an eating disorder or other psychiatric pathology probably contributed to several of the other deaths. Older age at the time the patient was seen at the specialist service was the only identifiable risk factor in the group of patients who died. The median length of time between diagnosis and death was 11 years.


CONCLUSIONS
Anorexia nervosa is associated with increased risk of premature death. It is possible that death rates could be reduced by early diagnosis and by long-term specialist care.
Millar
Harry R
HR
Department of Public Health, University of Aberdeen, Royal Cornhill Hospital, Aberdeen, Scotland AB25 2ZH, UK. harry.millar@gpct.grampian.scot.nhs.uk
Wardell
Fiona
F
Vyvyan
Juliet P
JP
Naji
Simon A
SA
Prescott
Gordon J
GJ
Eagles
John M
JM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013038:Specialization; D016019:Survival Analysis