Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review

Abstract Background Understanding of the epidemiology and health burden of eating disorders has progressed significantly in the last 2 decades. It was considered one of seven key areas to inform the Australian Government commissioned National Eating Disorder Research and Translation Strategy 2021–2031, as emerging research had highlighted a rise in eating disorder prevalence and worsening burden-of-illness. The aim of this review was to better understand the global epidemiology and impact of eating disorders to inform policy decision-making. Methods Using a systematic Rapid Review methodology, ScienceDirect, PubMed and Medline (Ovid) were searched for peer-reviewed studies published between 2009 and 2021. Clear inclusion criteria were developed in consultation with experts in the field. Purposive sampling of literature was conducted, which predominately focused on higher-level evidence (meta-analyses, systematic reviews, and large epidemiological studies), synthesised, and narratively analysed. Results 135 studies were deemed eligible for inclusion in this review (N = 1324). Prevalence estimates varied. Global Lifetime prevalence of any eating disorder ranged from 0.74 to 2.2% in males, and 2.58–8.4% in females. Australian 3-month point-prevalence of broadly defined disorders was around 16% in females. Eating disorders appeared more prevalent in young people and adolescents, particularly females (in Australia: eating disorders ~ 22.2%; disordered eating ~ 25.7%). Limited evidence was found on sex, sexuality and gender diverse (LGBTQI +) individuals, particularly males, who had a six-fold increase in prevalence compared to the general male population, with increased illness impact. Similarly, limited evidence on First Australian’s (Aboriginal and Torres Strait Islander) suggests prevalence rates similar to non-Indigenous Australians. No prevalence studies were identified specifically assessing culturally and linguistically diverse populations. Global disease burden of any eating disorder was 43.4 age-standardised disability-adjusted-life-years per 100,000; increasing by 9.4% between 2007 and 2017. Australian’s total economic cost was estimated at $84 billion from years-of-life lost due to disability and death, and annual lost earnings ~ $1.646 billion.” Conclusions There is no doubt that eating disorder prevalence and impact are on the rise, particularly in at-risk and understudied populations. Much of the evidence came from female-only samples, and Western, high-income countries which more readily have access to specialised services. Future research should examine more representative samples. There is an urgent need for more refined epidemiological methods to better understand these complex illnesses over time, to guide health policy and development-of-care.

摘要：
背景：近二十年来，人们对进食障碍（eating disorders）的流行病学特征与健康负担的认知取得了显著进展。鉴于新兴研究已揭示进食障碍患病率上升与疾病负担加重的现状，该领域被列为澳大利亚政府委托制定的《2021—2031年全国进食障碍研究与转化战略》的七大核心领域之一。本综述旨在深入阐明进食障碍的全球流行病学特征与影响，为政策决策提供参考依据。

研究方法：本研究采用系统性快速综述（systematic Rapid Review）方法，检索ScienceDirect、PubMed及Medline (Ovid)数据库中2009年至2021年间发表的同行评议论文。研究团队结合领域内专家意见制定了明确的纳入标准，采用目的性抽样法筛选文献，主要聚焦于高等级证据（包括Meta分析、系统性综述及大型流行病学研究），并对其进行综合归纳与叙述性分析。

研究结果：本综述共纳入135项符合标准的研究（总样本量N=1324）。患病率估算结果存在差异：全球范围内，任意类型进食障碍的终身患病率在男性中为0.74%~2.2%，女性中为2.58%~8.4%。澳大利亚女性中，宽泛定义的进食障碍3个月时点患病率约为16%。进食障碍在青少年群体中更为高发，尤以女性为甚（澳大利亚数据：进食障碍患病率约22.2%，失调性进食患病率约25.7%）。针对性少数、性取向及性别多元（LGBTQI+）群体的研究证据较为有限，其中男性群体的患病率较普通男性人群高出6倍，且疾病负担更重。同理，关于澳大利亚原住民（Aboriginal and Torres Strait Islander）的相关研究证据同样有限，其患病率与非原住民澳大利亚人群相近。目前尚未发现专门针对文化与语言多元群体的患病率研究。全球任意类型进食障碍的疾病负担为每10万人中43.4个年龄标化伤残调整生命年（disability-adjusted-life-years, DALY），2007年至2017年间增长了9.4%。澳大利亚因进食障碍导致的伤残与早逝所致生命年损失，以及年度收入损失的总经济成本约为840亿澳元，年度收入损失约为16.46亿澳元。

研究结论：毋庸置疑，进食障碍的患病率与疾病负担均呈上升趋势，在高风险群体与研究不足的人群中尤为显著。现有多数研究证据仅来自女性样本，以及可便捷获取专科服务的西方高收入国家。未来的研究应采用更具代表性的研究样本。当前亟需优化流行病学研究方法，以长期深入解析这类复杂疾病，从而为卫生政策制定与诊疗服务发展提供指导。