Tabler Jennifer, Utz Rebecca L
University of Wyoming, Department of Criminal Justice and Sociology, Laramie, WY, 82070, United States.
University of Utah, Department of Sociology, Salt Lake City, UT, 84112, United States.
SSM Popul Health. 2020 Sep 30;12:100672. doi: 10.1016/j.ssmph.2020.100672. eCollection 2020 Dec.
Eating Disorders (ED) are defined as abnormal eating behaviors, stemming from an obsession with food, body weight, or body shape. EDs affect 10 million men and 20 million women in the US, with an estimated 15% lifetime prevalence among women. An ED diagnosis is often accompanied with a host of adverse physical and mental health outcomes, including a heightened risk for suicidality. Given the complex comorbidities associated with EDs, treatment occurs in inpatient and outpatient settings. This study used linked administrative and health records from the Utah Population Database to create a cohort of women = 4183 and men = 423 who had a known diagnosis of ED between 1995 and 2015. Cox proportional hazard regression was used to model ED-related hospitalization trajectories, including subsequent risk for suicidality/self-injurious behavior-related hospitalization. To better estimate the risk profiles associated with different health care utilization patterns, models explored how family-related life course events (childbirth, marriage transitions) and sociodemographic characteristics (race, sex, and median income at census-block) modify hospitalization trajectories following initial diagnosis. Results suggested that increased outpatient treatment was associated with reduced risk of initial ED-related hospitalization, but higher risk for subsequent ED-related hospital readmission. In addition, transition to marriage (i.e., getting married) was associated with reduced risk of ED-related and suicidality/self-injurious behavior-related hospitalizations (initial hospitalization and subsequent readmission). Increased number of children was only associated with reduced risk of initial ED-hospitalization, but not readmission. When assessing individuals' risk for ED-related hospitalizations, social and health services researchers should contextualize treatment trajectories within the individual's life experiences, particularly marital transitions, while simultaneously considering sociodemographic characteristics and utilization of outpatient care. Future research should further examine whether marriage represents an important turning point in the health trajectories of individuals with EDs.
饮食失调（ED）被定义为源于对食物、体重或体型的痴迷的异常饮食行为。在美国，饮食失调影响着1000万男性和2000万女性，估计女性终生患病率为15%。饮食失调的诊断通常伴随着一系列不良的身心健康后果，包括自杀风险增加。鉴于饮食失调相关的复杂合并症，治疗在住院和门诊环境中进行。本研究使用了犹他州人口数据库中的关联行政和健康记录，创建了一个队列，其中女性 = 4183人，男性 = 423人，他们在1995年至2015年期间被确诊患有饮食失调。使用Cox比例风险回归对与饮食失调相关的住院轨迹进行建模，包括随后自杀/自我伤害行为相关住院的风险。为了更好地估计与不同医疗保健利用模式相关的风险概况，模型探讨了与家庭相关的生命历程事件（分娩、婚姻转变）和社会人口特征（种族、性别和人口普查街区的收入中位数）如何在初次诊断后改变住院轨迹。结果表明，门诊治疗增加与初次饮食失调相关住院风险降低有关，但随后饮食失调相关再次住院风险较高。此外，婚姻转变（即结婚）与饮食失调相关以及自杀/自我伤害行为相关住院（初次住院和随后再次住院）风险降低有关。子女数量增加仅与初次饮食失调住院风险降低有关，但与再次住院无关。在评估个体饮食失调相关住院风险时，社会和卫生服务研究人员应将治疗轨迹置于个体的生活经历中，特别是婚姻转变，同时考虑社会人口特征和门诊护理的利用情况。未来的研究应进一步探讨婚姻是否代表饮食失调个体健康轨迹中的一个重要转折点。
