Long-term trends in new and pre-existing eating disorder acute presentations among adolescents and young adults during and after the COVID-19 pandemic: a population-based cohort study

Purpose — To measure rates of emergency department (ED) visits and hospitalizations among adolescents and young adults with new and pre-existing eating disorders 3.5 years after the onset of the COVID-19 pandemic.

Methods — We conducted a population-based cross-sectional study using linked health administrative data for Ontario residents aged 10–17 years and 18–26 years during the prepandemic (January 1, 2017–February 29, 2020) and postpandemic periods (March 1, 2020–September 30, 2023). We used Poisson generalized estimating equations models to predict expected yearly overall and monthly age-stratified rates of eating disorder-related ED visits and hospitalizations using prepandemic trends among those with a new or pre-existing eating disorder.

Results — ED visit rates peaked above expected in 2021 among adolescents with new (adjusted rate ratio [aRR] 2.70, 95% confidence interval [CI; 2.34, 3.11]) and pre-existing eating disorders (aRR 3.38, 95% CI [2.70, 4.23]). Although ED visit rates decreased over time for adolescents, they remained higher than expected in 2023 for both new (aRR 1.37, 95% CI [1.16,1.63]) and pre-existing eating disorders (aRR 1.53, 95% CI [1.17, 2.01]). Hospitalization trends among adolescents mirrored these patterns. Among young adults, ED visit rates for new eating disorders peaked above expected levels in 2021 (aRR 1.21, 95% CI [1.15, 1.27]), whereas the peak for pre-existing eating disorders occurred in 2020 (aRR 1.45, 95% CI [1.22, 1.73]). By 2022, ED visit rates had returned to or dropped below expected levels.

Discussion — The surge in eating disorder–related acute care visits was limited to the pandemic, with rates mostly returning to baseline, although adolescent rates remain elevated. This highlights the need for continual monitoring of long-term trends to ensure that public health responses are informed by sustained data.