Pandemic Stringency Measures and Hospital Admissions for Eating Disorders
Authors: Roumeliotis Nadia , Carwana Matthew , Charland Katia , Trudeau Ofélie , Benigeri Mike , Diop Mamadou , Agostino Holly , Zinszer Kate , Amsdr Isra , Forgeot d’Arc Baudoin , Côté Sylvana , Basta Nicole E. , Fontela Patricia , Gantt Soren , Klassen Terry P. , Quach Caroline , Doan Quynh ,   Pediatric Outcomes Improvement Through Coordination of Research Networks (POPCORN) Investigators, Ahira Sarah , Ali Samina , Allen Upton , Baerg Krista , Bale-Nick Megan , Banerjee Ananya , Barton Michelle , Beer Darcy , Berthelot Simon , Bettinger Julie , Bhatt Maala , Buba Melanie , Buchanan Francine , Bullard Jared , Burstein Brett , Burton Catherine , Chanchlani Rahul , Chassé Michaël , Choong Karen , Constantin Evelyn , Constantinescu Cora , Costello Carrie , Côté Sylvana , Dewan Tammie , Di Genova Tanya , Drouin Olivier , Dryden-Palmer Karen , Du Pont- Thibodeau Geneviève , Dugas Marc-André , Dumont-Maurice Raven , Emeriaud Guillaume , Emsley Jason , Ferro Mark , Forbes Karen , Fortier Isabel , Foster Jennifer , Foulds Jessica , Freedman Stephen , Freire Gabrielle , Galanis Eleni , Gill Peter , Gravel Jocelyn , Gruenwoldt Emily , Guerra Gonzalo , Guttman Astrid , Hancock Betty Jean , Harrison Robyn , Holland Joanna , Joffe Ari , Kakkar Fatima , Kam April , Kellner James D. , Knisley Lisa , Lacaze-Masmonteil Thierry , Lalgudi Ganesan Saptharishi , Langlois Marc- André , Le Saux Nicole , Lee Laurie , Leifso Kirk , Li Patricia , Linares Andrea , Mahant Sanjay , Marc Isabelle , Mater Ahmed , McNally James , Meckler Garth , Morris Shaun , Mtaweh Haifa , Murthy Srin , Muttalib Fiona , Newhook Leigh- Anne , Nicoll Jessica , Orr-Gaucher Nathalie , Pagano Joseph , Pangilinan Anna , Papenburg Jesse , Pernica Jeffrey , Poonai Naveen , Portales-Casamar Elodie , Porter Robert , Purewal Rupeena , Robeson Paula , Robinson Joan , Sadarangani Manish , Salvadori Marina , Samuel Susan , Scott Shannon , Sehgal Anupam , Shah Archna , Sotindjo Tatiana , Southward Carla , Stoesz Taylor , Strang Robert , Suleman Shazeen , Szatmari Peter , Taheri Sepi , Tam Jennifer , Thibeault Roseline , Top Karina , Toulouse Krystel , Tse Sze-Man , Wadhwa Anupma , Wahi Gita , Wong Sam , Wright Bruce , Yeung Rae 
Published: July 2024

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.