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. 2024 Sep 1;178(9):879-887.
doi: 10.1001/jamapediatrics.2024.2044.

Pandemic Stringency Measures and Hospital Admissions for Eating Disorders

Nadia Roumeliotis  1   2 , Matthew Carwana  3   4 , Katia Charland  5 , Ofélie Trudeau  6 , Mike Benigeri  7 , Mamadou Diop  7 , Holly Agostino  8 , Kate Zinszer  5   9 , Isra Amsdr  10 , Baudoin Forgeot d'Arc  11 , Sylvana Côté  5 , Nicole E Basta  12 , Patricia Fontela  8   12 , Soren Gantt  6   13 , Terry P Klassen  14 , Caroline Quach  2   6   13 , Quynh Doan  3   4 ; Pediatric Outcomes Improvement Through Coordination of Research Networks (POPCORN) Investigators
Collaborators, Affiliations

Pandemic Stringency Measures and Hospital Admissions for Eating Disorders

Nadia Roumeliotis et al. JAMA Pediatr. .

Abstract

Importance: Hospitalizations for eating disorders rose dramatically during the COVID-19 pandemic. Public health restrictions, or stringency, are believed to have played a role in exacerbating eating disorders. Few studies of eating disorders during the pandemic have extended to the period when public health stringency restrictions were lifted.

Objective: To assess the association between hospitalization rates for eating disorders and public health stringency during the COVID-19 pandemic and after the easing of public health restrictions.

Design, setting, and participants: This Canadian population-based cross-sectional study was performed from April 1, 2016, to March 31, 2023, and was divided into pre-COVID-19 and COVID-19-prevalent periods. Data were provided by the Canadian Institute for Health Information and the Institut National d'Excellence en Santé et Services Sociaux for all Canadian provinces and territories. Participants included all children and adolescents aged 6 to 20 years.

Exposure: The exposure was public health stringency, as measured by the Bank of Canada stringency index.

Main outcomes and measures: The primary outcome was hospitalizations for a primary diagnosis of eating disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F50), stratified by region, age group, and sex. Interrupted time series analyses based on Poisson regression were used to estimate the association between the stringency index and the rate of hospitalizations for eating disorders.

Results: During the study period, there were 11 289 hospitalizations for eating disorders across 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 females within the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase in stringency 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), the Prairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). The excess COVID-19-prevalent period hospitalizations were highest at the 1-year mark, with increases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), and British Columbia (RR, 2.02).

Conclusion and relevance: In this cross-sectional study of hospitalizations for eating disorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17 years were associated with public health measure stringency. The findings suggest that future pandemic preparedness should consider implications for youths at risk for eating disorders and their resource and support needs.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Roumeliotis reported receiving grants from Fonds de Recherche Quebec Santé Research Scholar Junior 1 funding during the conduct of the study and from the Canadian Institutes for Health Research (CIHR) outside the submitted work. Dr Charland reported receiving grants from the CIHR during the conduct of the study. Dr Basta reported receiving grants from the CIHR/Pediatric Outcomes Improvement Through Coordination of Research Networks (POPCORN) to her institution during the conduct of the study and grants from Canada Research Chair (Tier 2), the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and McGill MI4 to her institution outside the submitted work. Dr Gantt reported receiving grants from Moderna during the conduct of the study and receiving grants from Moderna, Merck, VBI, Pfizer, GSK, Altona, and Meridian Biosciences and personal fees from Seqirus and Curevo outside the submitted work. Dr Doan reported receiving grants from the CIHR during the conduct of the study and outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Regional Stringency Index by 4-Week Intervals Between January 2020 and July 2022
Stringency was no longer measured after July 15, 2022. The stringency index used maximum stringency per 4-week interval provided by the Bank of Canada.
Figure 2.
Figure 2.. Interrupted Time Series of Eating Disorder Hospitalizations by Region and 4-Week Period From April 2016 to April 2023
Prepandemic trends were extrapolated into the COVID-19–prevalent period. “Expected” refers to counterfactual based on pre–COVID-19 pandemic trends. Expected and fitted rates are presented in eFigure 3 in Supplement 1. Shading around the expected rate line indicates 95% CIs.
See this image and copyright information in PMC

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