Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
Int J Eat Disord. 2024 Sep;57(9):1842-1853. doi: 10.1002/eat.24223. Epub 2024 Jun 12.
OBJECTIVE: This study investigates the overall and cause-specific mortality in males and females with anorexia nervosa (AN) from 1977 to 2018, focusing on the impact of psychiatric comorbidity on mortality risk, a less explored aspect despite a high prevalence in patients with AN. METHOD: We conducted a nationwide population-based cohort study in Denmark including all patients with AN (n = 14,774) with a median follow-up time of 9.1 years and a 1:10 age- and sex-matched general population comparison cohort. Using Cox proportional hazard model, we calculated adjusted hazard ratios (aHR) for death stratified by psychiatric comorbidity, sex, and age at AN onset and evaluated the causes of death using Fine and Gray sub-distribution hazard ratios (SHR). RESULTS: In patients with AN, the weighted average aHR for all-cause mortality was 4.5 [95% CI 4.1-4.9] with up to 40 years follow-up. Psychiatric comorbidity was present in 47% of patients with AN at index date, which was associated with a 1.9-fold increase in 10-year mortality compared with patients without comorbidity and a notably four-fold increase, when diagnosed at age 6-25 years. The mortality risk was similar according to sex. 13.9% of all deaths in patients with AN were due to suicide (SHR 10.7 [8.1-14.2]). The risk of dying of natural causes was increased with a SHR of 3.8 [95% CI 3.4-4.2]. DISCUSSION: The increased mortality risk in both males and females with AN and psychiatric comorbidity, particularly when diagnosed at young age, underscores the need for comprehensive treatment addressing both AN and coexisting psychiatric conditions. PUBLIC SIGNIFICANCE: The mortality in patients with anorexia nervosa (AN) is high and we show in our study that the mortality is doubled in the presence of psychiatric comorbidity particularly the first 10 years after diagnosis seen in both sexes and with suicide as a major cause of death. These findings stress the importance of detection and treatment of psychiatric comorbidities alongside the eating disorder to prevent fatal outcome.
目的：本研究旨在调查 1977 年至 2018 年间男性和女性厌食症（AN）患者的总体和特定原因死亡率，重点关注精神共病对死亡率风险的影响，尽管 AN 患者中精神共病的患病率很高，但这方面的研究仍较少。
方法：我们在丹麦进行了一项全国性基于人群的队列研究，纳入了所有 AN 患者（n=14774），中位随访时间为 9.1 年，并与 1:10 年龄和性别匹配的一般人群对照队列进行比较。使用 Cox 比例风险模型，我们按精神共病、性别和 AN 发病年龄对死亡进行分层，计算了调整后的死亡风险比（aHR），并使用 Fine 和 Gray 亚分布风险比（SHR）评估了死因。
结果：在 AN 患者中，全因死亡率的加权平均 aHR 为 4.5[95%CI 4.1-4.9]，最长随访时间达 40 年。在 AN 患者中，47%的患者在指数日期存在精神共病，与无共病患者相比，10 年死亡率增加了 1.9 倍，而在 6-25 岁时诊断为共病的患者，死亡率增加了近 4 倍。死亡率在性别间无差异。AN 患者中，13.9%的死亡归因于自杀（SHR 10.7[8.1-14.2]）。因自然原因死亡的风险增加，SHR 为 3.8[95%CI 3.4-4.2]。
讨论：患有 AN 和精神共病的男性和女性的死亡率风险增加，尤其是在年轻时诊断为共病时，这凸显了全面治疗 AN 和并存的精神疾病的必要性。
意义：AN 患者的死亡率很高，我们的研究表明，存在精神共病的患者死亡率增加一倍，特别是在诊断后的前 10 年，在两性中均如此，自杀是主要死因。这些发现强调了检测和治疗饮食障碍共病的重要性，以预防致命后果。
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