An audit of a British sample of death certificates in which anorexia nervosa is listed as a cause of death

Abstract

National mortality statistics derived from death certificates are a flawed source of information on deaths from anorexia nervosa when taken at face value. There may be both underreporting and overreporting. Detailed examination may improve their usefulness by reducing the overerreporting. It seems likely that the association of deaths with anorexia nervosa is systematically underreported.

Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates

“…The authors argue that this dramatic decrease in mortality is related to the introduction of specialized care units for patients with eating disorders. Finally, in an audit conducted in the UK, death certificates emerged as a flawed source of information with both over- and underreporting of AN as a cause of death, the latter probably more common [19, 57]. …”

Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England, 2001–2009

“…The reliability of the broad groupings of cause of death used by us is more questionable. The accuracy of specific causes of death recording is debated, especially deaths from unnatural causes including suicide and undetermined intent . Another potential limitation is the fact that the data on hospital admissions are confined to the NHS, whereas a number of young people are treated entirely within the independent sector, and not recorded in this study.…”

Eating disorders in men aged midlife and beyond

“…Using an alternative approach, some studies have examined death certificates or medical records from population registers to identify deaths associated with AN [37][38][39]. Hewitt et al [37] reviewed 10 million U.S. death records from 1986 to 1990 using the National Center for Health Statistics.…”

“…Indeed, a careful audit of British death certificates found that only 128 of 230 deaths in which AN was listed as the cause of death (1993)(1994)(1995)(1996)(1997)(1998)(1999) were likely associated with a true psychiatric diagnosis of anorexia nervosa [38]. On the other hand, it should be acknowledged that under-recognition or misclassification of ED symptoms among older men, in particular, may comprise a significant portion of untreated cases.…”