Klimek-Johnson Patrycja, Jacobson Isabel G, Geronimo-Hara Toni Rose, Sharifian Neika, McMaster Hope S, Rull Rudolph P, Maguen Shira
San Francisco Veterans Affairs Health Care System, Mental Health Service, San Francisco, CA, United States.
Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, CA, United States.
Am J Epidemiol. 2025 Jun 3;194(6):1642-1649. doi: 10.1093/aje/kwae207.
Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. This study examined independent associations and interactions among sex, race, ethnicity, and probable BED and BN onset. The sample included 91 413 and 96 245 service members and veterans from the Millennium Cohort Study for BED and BN analyses, respectively. Up to 4 data points (2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, multiracial, Black, and Asian/Pacific Islander (API) service members, whereas BED was less likely among Black and API participants compared with non-Hispanic/Latinx White service members. Interactions revealed a greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed among racially and ethnically diverse groups to prevent and detect EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.
神经性贪食症（BN）和暴饮暴食症（BED）是军事人员中最常见的饮食失调症（EDs）。尽管在军事人员和平民样本中饮食失调症的患病率存在性别差异，但在评估种族差异时出现了不一致的结果。本研究调查了性别、种族、民族与可能的暴饮暴食症和神经性贪食症发病之间的独立关联和相互作用。样本分别包括来自千年队列研究的91413名和96245名现役军人和退伍军人，用于暴饮暴食症和神经性贪食症分析。由于对参与者进行随访直至结果出现或研究结束，因此使用了多达4个数据点（2001 - 2013年）进行纵向互补对数-对数回归分析。神经性贪食症在女性中比男性更常见，而暴饮暴食症的发病没有性别差异。在西班牙裔/拉丁裔、多种族、黑人以及亚裔/太平洋岛民（API）现役军人中，神经性贪食症更为常见，而与非西班牙裔/拉丁裔白人现役军人相比，黑人及API参与者患暴饮暴食症的可能性较小。相互作用分析显示，西班牙裔/拉丁裔现役军人中神经性贪食症更常见是由男性驱动的。需要在不同种族和族裔群体中做出更多努力，以预防和检测军事人员中的饮食失调症。未来的交叉性研究可以阐明饮食失调症发病的系统性不平等和其他促成因素，为预防和治疗工作提供信息。
