Document Type
Article
Publication Date
July 2024
Journal
JAMA Pediatrics
URL with Digital Object Identifier
10.1001/jamapediatrics.2024.2044
Abstract
IMPORTANCE Hospitalizations for eating disorders rose dramatically during the COVID-19pandemic. Public health restrictions, or stringency, are believed to have played a role inexacerbating eating disorders. Few studies of eating disorders during the pandemic haveextended to the period when public health stringency restrictions were lifted.OBJECTIVE To assess the association between hospitalization rates for eating disorders andpublic health stringency during the COVID-19 pandemic and after the easing of public healthrestrictions.DESIGN, SETTING, AND PARTICIPANTS This Canadian population-based cross-sectional studywas performed from April 1, 2016, to March 31, 2023, and was divided into pre–COVID-19 andCOVID-19–prevalent periods. Data were provided by the Canadian Institute for HealthInformation and the Institut National d’Excellence en Santé et Services Sociaux for allCanadian provinces and territories. Participants included all children and adolescents aged 6to 20 years.EXPOSURE The exposure was public health stringency, as measured by the Bank of Canadastringency index.MAIN OUTCOMES AND MEASURES The primary outcome was hospitalizations for a primarydiagnosis of eating disorders (International Statistical Classification of Diseases and RelatedHealth Problems, Tenth Revision code F50), stratified by region, age group, and sex.Interrupted time series analyses based on Poisson regression were used to estimate theassociation between the stringency index and the rate of hospitalizations for eating disorders.RESULTS During the study period, there were 11 289 hospitalizations for eating disordersacross Canada, of which 8726 hospitalizations (77%) were for females aged 12 to 17 years.Due to low case counts in other age-sex strata, the time series analysis was limited to femaleswithin the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase instringency was associated with a significant increase in hospitalization rates in Quebec(adjusted rate ratio [ARR], 1.05; 95% CI, 1.01-1.07), Ontario (ARR, 1.05; 95% CI, 1.03-1.07), thePrairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). Theexcess COVID-19–prevalent period hospitalizations were highest at the 1-year mark, withincreases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), andBritish Columbia (RR, 2.02).CONCLUSION AND RELEVANCE In this cross-sectional study of hospitalizations for eatingdisorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17years were associated with public health measure stringency. The findings suggest that futurepandemic preparedness should consider implications for youths at risk for eating disordersand their resource and support needs.