Brown Tashalee R, Jansen Madeline O, Zhou A Ning, Moog Dominic, Xie Hui, Liebesny Katherine V, Xu Kevin Y, Lin Binx Y, Deng Wisteria Y
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, CA, United States.
Jane and Terry Semel Institute for Neuroscience and Human Behavior at University of California-Los Angeles (UCLA), Los Angeles, CA, United States.
Front Psychiatry. 2024 Aug 20;15:1402312. doi: 10.3389/fpsyt.2024.1402312. eCollection 2024.
Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data.
To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic.
We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person's index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient's first ED diagnosis. We applied propensity score-matched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022.
Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95%CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort.
Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the pre-pandemic 2017-2019 cohort, even after controlling for baseline levels of co-occurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults.
自闭症、注意力缺陷多动障碍（ADHD）和性别焦虑症（GD）的发病率不仅在普通人群中呈上升趋势，在患有饮食失调症（EDs）的儿童、青少年和年轻人中上升尤为明显。虽然在新冠疫情期间饮食失调症的发病率有所上升，但自闭症、ADHD和GD共病的趋势尚未通过大型电子病历数据进行详细或大规模的调查。
调查在2019冠状病毒病大流行之前及期间，患有饮食失调症的儿童、青少年和年轻人中自闭症、ADHD和GD共病率的趋势。
我们使用了一个经过去识别处理的跨国电子健康记录数据库（TriNetX），其中有48558名年龄在5至26岁之间的个体，在2017年至2022年期间至少被诊断出患有两次饮食失调症。主要预测变量区分了每个人首次饮食失调症诊断的年份（2017 - 2019年与2020 - 2022年）。主要结果变量是每位患者首次饮食失调症诊断后一年内新出现的自闭症、ADHD和GD共病精神诊断率。我们应用倾向得分匹配的多变量逻辑回归来比较2017 - 2019年和2020 - 2022年之间的主要结果。
我们的分析包括2017 - 2019年被诊断出患有饮食失调症的17445人（8%患有自闭症，13.5%患有ADHD，1.9%患有GD）以及2020 - 2022年被诊断出患有饮食失调症的31113人（8%患有自闭症，14.6%患有ADHD，3.2%患有GD）。在1:1倾向得分匹配后，2017 - 2019队列中的17202人与2020 - 2-2队列中的同龄人进行了匹配。与2017 - 2019队列相比，在2020 - 2022年被诊断出的患者在首次饮食失调症诊断后的365天内，自闭症、ADHD和GD诊断的几率分别增加了19%（调整后比值比[aOR][95%置信区间]=1.19[1.07 - 1.33]）、25%（aOR = 1.25[1.04 - 1.49]）和36%（aOR = 1.36[1.07 - 1.74]）。
与疫情前的2017 - 2019队列相比，在2020 - 2022疫情后队列中，患有饮食失调症的个体自闭症、ADHD和GD的发病率显著更高，即使在控制了共病精神诊断的基线水平之后。这些发现揭示了我们目前对2019冠状病毒病可能影响儿童、青少年和年轻人饮食失调症、自闭症、ADHD和GD的发病及临床过程的所有方式的理解存在重大差距。
