Acute presentations of eating disorders among adolescents and adults before and during the COVID-19 pandemic in Ontario, Canada

Background — Increased rates of pediatric eating disorders have been observed during the COVID-19 pandemic, but little is known about trends among adults. We aimed to evaluate rates of emergency department visits and hospital admissions for eating disorders among adolescents and adults during the pandemic.

Methods — We conducted a population-based, repeated cross-sectional study using linked health administrative data for Ontario residents aged 10–105 years during the prepandemic (Jan. 1, 2017, to Feb. 29, 2020) and pandemic (Mar. 1, 2020, to Aug. 31, 2022) periods. We evaluated monthly rates of emergency department visits and hospital admissions for eating disorders, stratified by age.

Results — Compared with expected rates derived from the prepandemic period, emergency department visits for eating disorders increased during the pandemic among adolescents aged 10–17 years (7.38 v. 3.33 per 100 000; incidence rate ratio [IRR] 2.21, 95% confidence interval [CI] 2.17–2.26), young adults aged 18–26 years (2.79 v. 2.46 per 100 000; IRR 1.13, 95% CI 1.10–1.16) and older adults aged 41–105 years (0.14 v. 0.11 per 100 000; IRR 1.15, 95% CI 1.07–1.24). Hospital admissions for eating disorders increased during the pandemic for adolescents (8.82 v. 5.74 per 100 000; IRR 1.54, 95% CI 1.54–1.54) but decreased for all adult age groups, especially older adults aged 41–105 years (0.21 v. 0.30 per 100 000; IRR 0.72, 95% CI 0.64–0.80).

Interpretation — Emergency department visits for eating disorders increased among adolescents, young adults and older adults during the pandemic, but hospital admissions increased only for adolescents and decreased for all adult groups. Differential rates of acute care use for eating disorders by age have important implications for allocation of inpatient mental health resources.