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. 2021 Jun;26(5):1627-1637.
doi: 10.1007/s40519-020-00960-1. Epub 2020 Aug 13.

Mortality in males as compared to females treated for an eating disorder: a large prospective controlled study

Manfred M Fichter  1   2 , Silke Naab  3 , Ulrich Voderholzer  3 , Norbert Quadflieg  4
Affiliations

Mortality in males as compared to females treated for an eating disorder: a large prospective controlled study

Manfred M Fichter et al. Eat Weight Disord. 2021 Jun.

Abstract

Purpose: To report on the mortality of DSM-IV eating disorders and predictors of premature death in males compared to females after inpatient treatment.

Methods: Crude mortality rate (CMR) and standardized mortality ratio (SMR) were computed for a large sample of males aged at treatment 16-61 years [N = 66 anorexia nervosa (AN), 52 bulimia nervosa (BN), 70 eating disorder not otherwise specified (ED-NOS)] and females aged 14-65 years (N = 2066 AN, 1880 BN, 1350 ED-NOS). In addition, a survival analysis and Cox regression analyses for identifying predictors of death were computed.

Results: CMRs for males and females, respectively, were 15% and 5% in AN, 8% and 3% in BN, and 4% and 3% in ED-NOS. Compared to the general population, mortality was elevated in males with AN (SMR = 4.93) and in all female diagnostic groups (AN, BN, ED-NOS). No significant sex differences for SMR emerged in any diagnostic group. Compared to females with AN or BN, males with AN or BN showed a shorter survival time after onset (survival analysis). Being male, and having AN, increased the risk of premature death.

Conclusion: Mortality in inpatients with eating disorder is high, especially in AN. Males appear to have about the same outcome in terms of mortality as females with AN, BN, and ED-NOS. However, long-term survival was shorter in males with AN or BN compared to females. The need for intensive treatment in both males and females with an eating disorder remains an important issue.

Level of evidence: Level III, case-control analytic study.

Keywords: Anorexia nervosa; Bulimia nervosa; Eating disorders; Females; Males; Standardized mortality ratio.

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