Nielsen S, Møller-Madsen S, Isager T, Jørgensen J, Pagsberg K, Theander S
University Department of Child and Adolescent Psychiatry, Bispebjerg Hospital, Copenhagen, Denmark.
J Psychosom Res. 1998 Mar-Apr;44(3-4):413-34. doi: 10.1016/s0022-3999(97)00267-5.
Ten eating disorder (ED) populations were reviewed using the standardized mortality ratio (SMR) presenting new evidence for several studies. In eight of the ten samples, strong evidence (in one sample weak evidence and in one sample no evidence) supports an hypothesis of elevated SMR. We found strong evidence for an increase in SMR for anorexia nervosa (AN), whereas no firm conclusions could be drawn for bulimia nervosa (BN). Bias caused by loss to follow-up was quantified and found non-negligable in some samples (possible increase in SMR from 25% to 240%). We did not find a significant effect of gender or time period on SMR. Survival analysis showed a significant difference among the life-tables for males and females; female risk of death averaged 0.59% per year, whereas all male deaths occurred within the first 2 years after presentation. Weight at presentation had a highly significant effect on SMR, and lower weight at presentation was associated with higher SMR. Age at presentation exerted a significant unimodal effect on SMR; aggregate overall SMR was 3.6 for the youngest age group (< 20 years), 9.9 for those aged 20-29 years, and 5.7 for those aged > or = 30 years at presentation. Length of follow-up had a highly significant inverse effect on SMR; maximal SMR was 30 for female AN patients in the first year after presentation. A statistically significant increase in SMR was documented for at least up to 15 years after presentation. One study indicated a treatment effect on SMR. New evidence on causes of death suggests there are more deaths from suicide and other and unknown causes and fewer deaths related to ED than previously reported. Our findings have both research and clinical implications, with the most important clinical implication being the need for vigorous and well-directed treatment efforts from the initial presentation for treatment. An important research implication is that no single measure of mortality is sufficient; that is, only a combination of different statistics will maximize the available information.
使用标准化死亡比（SMR）对十个饮食失调（ED）人群进行了回顾，为多项研究提供了新证据。在十个样本中的八个样本中，有力证据（一个样本为弱证据，一个样本无证据）支持SMR升高的假设。我们发现神经性厌食症（AN）的SMR有显著升高的有力证据，而对于神经性贪食症（BN）则无法得出确凿结论。对失访导致的偏差进行了量化，发现在某些样本中不可忽视（SMR可能从25%增加到240%）。我们没有发现性别或时间段对SMR有显著影响。生存分析显示男性和女性的生命表之间存在显著差异；女性每年的死亡风险平均为0.59%，而所有男性死亡都发生在就诊后的头两年内。就诊时的体重对SMR有高度显著影响，就诊时体重较低与SMR较高相关。就诊时的年龄对SMR有显著的单峰效应；最年轻年龄组（<20岁）的总体SMR为3.6，20 - 29岁年龄组为9.9，就诊时年龄≥30岁的年龄组为5.7。随访时间对SMR有高度显著的反向影响；女性AN患者就诊后第一年的最大SMR为30。记录到就诊后至少15年内SMR有统计学显著增加。一项研究表明治疗对SMR有影响。关于死亡原因的新证据表明，自杀及其他不明原因导致的死亡比以前报告的更多，与饮食失调相关的死亡比以前报告的更少。我们的发现具有研究和临床意义，最重要的临床意义是从首次就诊开始就需要积极且针对性强的治疗措施。一个重要的研究意义是，没有单一的死亡率衡量标准是足够的；也就是说，只有不同统计数据的组合才能最大限度地利用现有信息。
