Researchers 'Astonished' by Anorexia Death Rates

Anorexia nervosa, as psychiatrists know only too well, is a dangerous illness with a high rate of premature death.

But exactly how dangerous has become clearer—the result of a nationwide longitudinal study conducted by Swedish scientists.

The study team reported two major findings. The first was that compared with the general population, anorexia patients were at a heightened risk of death not only after hospitalization but many years later. The second was that their long-term risk of death came not just from anorexia but from a number of other causes as well.

The scientists were “astonished” by these findings, they wrote in their report published in the January British Journal of Psychiatry.

Thanks to the unique personal identification numbers assigned to all Swedish residents, and to the national cause-of-death records and national hospital-discharge records that Sweden maintains, these researchers were able to assess death from natural and unnatural causes in a nation-wide cohort of Swedish women with anorexia nervosa. The researchers studied the records of some 6,000 patients covering a 30-year period (1973 to 2003).

Out of the cohort studied, 265 died during the 30-year follow-up. The most frequent causes of death were suicide (responsible for 32 percent of the deaths), anorexia (19 percent of the deaths), and cancer (11 percent of the deaths). The remaining 38 percent of deaths were caused by other illnesses or by homicide. The average age at death for the 265 anorexia patients who died was 34.

The researchers also compared findings for their anorexia patients during the 30-year follow-up period with those of the general Swedish population. For example, compared with the general population during this time, anorexia subjects were 19 times more likely to have died from psychoactive substance use, primarily alcohol use, 14 times more likely to have died from suicide; 12 times more likely to have died from respiratory diseases, 11 times more likely to have died from urogenital diseases, five times more likely to have died from gastrointestinal diseases, and two times more likely to have died from either cardiovascular disease or from cancer.

Altogether, anorexia patients were six times more likely to have died during the 30-year follow-up period than was the general population.

“These results underline the need for careful follow-up of anorexia nervosa patients,” Fotios Papadopoulos, M.D., Ph.D., a general psychiatry resident at Sweden's Uppsala University Hospital and the lead investigator, told Psychiatric News. For instance, anorexia patients' five-fold increase in deaths due to gastrointestinal diseases may have been due, at least in part, to the indirect effects of alcohol abuse since 4 out of 6 deaths in this category were from liver cirrhosis. Moreover, other researchers have found that a number of patients with anorexia do not have alcohol problems during the first part of their illness, yet develop them later. Thus, anorexia patients should be carefully monitored for signs that they may be developing alcohol dependence.

Some good news also emerged from the study, the researchers noted, in that the death rates for patients first admitted to the hospital from 1987 to 2003 for anorexia were substantially lower than those for patients first admitted to the hospital for anorexia from 1973 to 1979. The researchers believe that this downward trend reflects improved psychiatric and other medical care for anorexia patients in recent years.

The study was funded by the Swedish Research Council.

An abstract of “Excess Mortality, Causes of Death, and Prognostic Factors in Anorexia Nervosa” is posted at<http://bjp.rcpsych.org/cgi/content/abstract/194/1/10>.▪