Re-examining premature mortality in anorexia nervosa: A meta-analysis redux

Familial Liability for Eating Disorders and Suicide Attempts

“…[3][4][5] Based on meta-analyses, approximately 1 of 5 premature deaths in patients with AN was due to suicide 2 ; suicide-specific standardized mortality ratios were estimated to be 18.1 in AN 4 and 7.5 in BN. 3 However, studies included in the meta-analyses reported considerably varied estimates, possibly owing to differences in follow-up time, source, sample size, and representativeness of the samples.…”

Eating disorders in men aged midlife and beyond

“…Very little remains known about risk of premature death due to ED in males. The surprisingly high proportion of older, male deaths on death certificates listing anorexia nervosa as an associated or underlying cause of death is incongruent with a meta-analysis observing fewer deaths in studies with a higher percentage of males [34]. Misclassification from inappropriate or inaccurate registration procedures is a likely source of bias when examining death certificates for anorexia nervosa without linkage to a well-defined clinical sample or patient register, although males may indeed comprise a significant portion of untreated cases.…”

“…No male data were used, in accordance with the majority of participants included in the trials. A meta-analysis by Keshaviah et al [34] re-extracted and re-analyzed source data from prior meta-analyses [32,33] utilizing a rigorous approach to avoid duplicate entries and include cohorts with zero deaths without artificially altering data through continuity corrections. As done with prior meta-analyses, standard mortality ratios were calculated using official statistics for females aged 24-34 years.…”

“…As done with prior meta-analyses, standard mortality ratios were calculated using official statistics for females aged 24-34 years. Keshaviah et al [34] estimated that individuals with AN are 5.2 times more likely to die prematurely from any cause and 18.1 times more likely to die by suicide. Interestingly, their examination of study-level predictors of mortality revealed that fewer deaths were observed in studies with a higher percentage of males [34].…”

“…Limitations and methodological uncertainties significantly plague our ability to understand the effects of age and gender on mortality. However, accurate mortality estimates are very important for policy-making, funding allocation, and clinical decision-making [34] and along these lines, we argue that reliable mortality data are especially important to draw attention and resources to more diverse, non-traditional presentations of ED including older men.…”