STANDARDIZED MORTALITY IN EATING DISORDERS - A QUANTITATIVE SUMMARY OF PREVIOUSLY PUBLISHED AND NEW EVIDENCE

Ten eating disorder (ED) populations were reviewed using the standardi zed mortality ratio (SMR) presenting new evidence for several studies. In eight of the ten samples, strong evidence (in one sample weak evid ence and in one sample no evidence) supports an hypothesis of elevated SR?IR. We found strong evidence for an increase in SMR for anorexia n ervosa (AN), whereas no firm conclusions could be drawn for bulimia ne rvosa (BN). Bias caused by loss to follow-up was quantified and found non-negligable in some samples (possible increase in SMR from 25% to 2 40%). 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 SR IR, 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 greater than o r equal to 30 years at presentation. Length of follow-up had a highly significant inverse effect on SMR; maximal SMR was 30 for female AN pa tients in the first year after presentation. A statistically significa nt increase in SMR was documented for at least up to 15 years after pr esentation. One study indicated a treatment effect on SMR. New evidenc e on causes of death suggests there are more deaths from suicide and o ther 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 vigoro us and well-directed treatment efforts from the initial presentation f or treatment. An important research implication is that no single meas ure of mortality is sufficient; that is, only a combination of differe nt statistics will maximize the available information. (C) 1998 Elsevi er Science Inc.