title: Trends in hospital admission rates for anorexia nervosa in Oxford (1968-2011) and England (1990-2011): database studies.
abstract: OBJECTIVE
  To report on long-term trends in hospital admission rates for anorexia nervosa using two English datasets.
  
  
  METHODS
  We used data on hospital day-case and inpatient care across five decades in the Oxford Record Linkage Study (ORLS), and similar data for all England from 1990. We analysed rates of admission for anorexia nervosa in people aged 10-44 years, using hospital episodes (counting every admission) and first-recorded admissions (counting only the first record for each person).
  
  
  METHODS
  Former Oxford NHS Region; and England.
  
  
  METHODS
  None; anonymous statistical records were used.
  
  
  RESULTS
  In the longstanding ORLS, the age-standardised first-recorded admission rate for women was 2.7 (95% confidence interval 1.6-3.8) per 100,000 female population aged 10-44 years in 1968-1971; 2.7 (2.1-3.3) in 1992-1996; and 6.3 (5.5-7.2) in 2007-2011. Male rates were zero in the 1960s; 0.07 (0.0-0.1) per 100,000 men in 1992-1996; and 0.4 (0.2-0.6) in 2007-2011. In England, female rates increased from 4.2 (4.0-4.4) in 1998-2001 to 6.9 (6.7-7.1) in 2007-2011; and the corresponding male rates were 0.2 (0.1-0.3) and 0.5 (0.4-0.6). Episode-based admission rates rose more than person-based rates. The highest rates by far were in girls and women aged 15-19 years.
  
  
  CONCLUSIONS
  In recent years, anorexia nervosa has become a greater burden on secondary care: not only have admission rates increased but so too have multiple admissions per person with anorexia nervosa. The increase in admission rates might reflect an increase in prevalence rates of anorexia nervosa in the general population, but other explanations, including lower clinical thresholds for admission, are possible and are discussed.
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK.
authors.forename: Josephine
authors.initials: J
authors.lastname: Holland
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Hall
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK.
authors.forename: David G R
authors.initials: DG
authors.lastname: Yeates
authors.affiliation: Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, UK Michael.goldacre@dph.ox.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Goldacre
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000856:Anorexia Nervosa / Q000453:epidemiology*; D002648:Child; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D010343:Patient Admission / Q000639:trends*; D017678:Sex Distribution; D055815:Young Adult
keywords: Anorexia nervosa; admission rates; eating disorders; hospital trends; mortality rates