title: Re-examining premature mortality in anorexia nervosa: a meta-analysis redux.
abstract: Anorexia nervosa (AN) is reported to have the highest premature mortality of any psychiatric disorder, but recent meta-analyses may have inflated estimates. We sought to re-estimate mortality after methodological corrections and to identify predictors of mortality. We included 41 cohorts from 40 peer-reviewed studies published between 1966 and 2010. Methods included double data extraction, log-linear regression with an over-dispersed Poisson model, and all-cause and suicide-specific standardized mortality ratios (SMRs), with 95% Poisson confidence intervals. Participants with AN were 5.2 [3.7-7.5] times more likely to die prematurely from any cause, and 18.1 [11.5-28.7] times more likely to die by suicide than 15-34 year old females in the general population. Our estimates were 10% and 49% lower, respectively, than previously reported SMRs. Risk of premature mortality was highest in studies with older participants, although confounding by treatment was present. Gender, ascertainment, and diagnostic criteria also impacted risk.
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Keshaviah
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Edkins
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; The Amundsen Group, Burlington, MA, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Hastings
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Krishna
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Northeastern University, Boston, MA, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Franko
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Herzog
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Thomas
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Helen B
authors.initials: HB
authors.lastname: Murray
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: keddy@mgh.harvard.edu.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D061213:Mortality, Premature; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult