Research Snapshot: Identifying people with eating disorders using health administrative data

What you need to know

There is limited data on the prevalence of eating disorders (EDs) in Canada. This study is the first to use Ontario’s health administrative data to identify patients with EDs, such as anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified.

 

This Research Snapshot looks at the article, "Identifying Individuals with Eating Disorders Using Health Administrative Data,” which was published in The Canadian Journal of Psychiatry in 2020. Read it below or download the PDF

Research Snapshots are brief, clear language summaries of research articles, presented in a user-friendly format.

What you need to know

There is limited data on the prevalence of eating disorders (EDs) in Canada. This study is the first to use Ontario’s health administrative data to identify patients with EDs, such as anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified.

What is this research about?

The term “eating disorders” includes anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding and eating disorders. Although these disorders are common, there is less awareness of EDs compared to other mental health conditions by the general population and health care providers, likely because there is limited data and no way to measure the burden of these disorders on patients, society and the health system.

While registries of ED patients exist in other countries, they are often restricted to insured or clinical populations, which may not reflect Ontario’s situation. Health data can facilitate research and help measure the prevalence and burden of these disorders.

The researchers developed a clinical case series of all ED patients from Ontario hospitalization data between 1990 and 2014. The authors evaluated the impact of varying rules to include patients in the cohort. They compared patients with EDs included in the cohort with members of the general population not in the cohort, and determined that patients with EDs are markedly different from members of the general public.

As established, the cohort will be used to answer a number of questions about the burden of illness and mortality experienced by ED patients in Ontario. The cohort can also be used to propose opportunities to increase access to care and to evaluate clinical and program models to minimize adverse outcomes and address potential service gaps.

What did the researchers do?

The researchers used administrative health records in Ontario from the Institute for Clinical Evaluative Sciences to identify three clinically relevant eating disorder cohorts between 1990 and 2014. As part of validation of the cohort and understanding the data, they identified the  following three nested cohorts, each sequentially expanding the rules for inclusion:

1. patients hospitalized with an eating disorder diagnosis as the main diagnosis

2. patients hospitalized with an eating disorder diagnosis as any diagnosis

3. cohort 2 plus patients with an emergency department visit associated with an ED diagnosis.

What did the researchers find?

The researchers determined that all three inclusion criteria resulted in a cohort with fairly similar characteristics, although the most restrictive cohort missed patients diagnosed with bulimia nervosa and eating disorders not otherwise specified. The cohorts all differed from the underlying population in terms of patient demographics (i.e., sex, ethnicity, migrant status, neighbourhood income, use of social assistance and rural residence) and any other medical conditions.

In all three cohorts, patients with EDs were about 90% female and, on average, about 30 years old. Ethnic (or racial-ethnic) minorities and immigrants were less likely to have been identified as having an eating disorder in hospital contact data.

How can you use this research?

This research provides approaches to using health administrative data to estimate the burden of EDs among Ontarians. Further research using the cohort can enhance health service research by building and improving the Ontario health administration data system to capture accurate and relevant health information from patients who might have an ED.

Limitations and next steps

The researchers note that their findings should be considered with caution because the methods they used did not include many Ontario residents with EDs, such as those who are misdiagnosed or not diagnosed and those who are treated outside of a hospital.

About the researchers

Paul Kurdyak,1,2,3,4 Claire de Oliveira,1,2,4 Tomi Iwajomo,1 Susan Bondy,5 Kathryn Trottier,3,6 Patricia Colton,6

  1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario
  2. Institute for Clinical Evaluative Sciences, Toronto, Ontario
  3. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
  4. Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario
  5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
  6. University Health Network, Toronto, Ontario

Keywords 

Eating disorders, epidemiology, disease surveillance, mental health

This Research Snapshot is based on the article, “Identifying Individuals with Eating Disorders Using Health Administrative Data,” which was published in The Canadian Journal of Psychiatry in 2020. https://doi.org/10.1177/0706743719844183. This summary was written by Rupinder Chera.