Adolescent Medicine Kaiser Permanente Northern California Kaiser Permanente Northern California Hayward, California, United States
Background: Eating disorders among children and adolescents are prevalent and can negatively impact their mental and physical health over the lifespan. Few studies examined incidence and hospitalization rates among children with eating disorders in the United States.
Objective: Examine incidence and hospitalization rates of pediatric patients aged 8-18 with eating disorder diagnoses in Kaiser Permanente Northern California between January 2015 and June 2019.
Design/Methods: Data were extracted from membership and electronic health record systems. Incident eating disorder cases included patients with any ICD-9 (2015) and ICD-10 (2016-2019) visit diagnoses associated with eating disorders. Hospitalizations included medical hospitalizations at any of the 13 KPNC hospitals with any eating disorder encounter diagnosis. Multivariable generalized linear mixed models examined the association of hospitalization with index year, age, sex, race/ethnicity, % median body mass index (%mBMI), eating disorder diagnosis, co-morbid mental health diagnoses and Medicaid insurance status.
Results: 4,883 children and adolescents were diagnosed with an eating disorder between 2015-2019. 22% were male, 10.8% Asian, 4.3% black, 26.7% Hispanic/Latinx, 8.4% multiracial, and 45.6% white. At time of diagnosis, 13% had BMI <5th%ile, 61.8% had BMI between the 5th-84th%ile, and 19.7% had BMI above the 85th%ile. Incidence rates ranged between 177-205 per 100,000 children per year. 5.4% of children had eating disorder medical hospitalizations during 12 months of follow-up. Multivariable models found no difference in hospitalization rate by index year, age, sex or insurance status. Hispanic/Latinx children were less likely to be hospitalized than white children (AOR 0.62, 95% CI 0.44-0.87). Children with substance use disorders were more likely to be hospitalized than those without (AOR 2.01, 95%CI 1.20-3.37) while children with mood disorders were less likely to be hospitalized than those without (AOR 0.56, 95% CI 0.39-0.81). Conclusion(s): Contrary to the common stereotype of patients with eating disorders being underweight and mostly white, most children and adolescents in this study were non-white and had a weight in the normal or overweight/obese range. Hospitalization rates differed by race/ethnicity and comorbid mental health conditions. Future research calls for the examination of racial/ethnic disparities in eating disorder care and comorbid mental health conditions can affect treatment.
Authors/Institutions: Josephine S. Lau, Kaiser Permanente Northern California, San Leandro, California, United States; Stephen Uong, Kaiser Permanente Division of Research, Oakland, California, United States; Julie A. Schmittdiel, Kaiser Permanente Division of Research, Oakland, California, United States
