Hospitalizations for Eating Disorders Rose Over the Past Decade

Secondary diagnoses, costs,
and cases of
obesity in
children
all rose from 1999 to 2008.

A recent Healthcare Cost and Utilization Project (HCUP) report on hospitalizations for eating disorders showed a 24% increase in hospital stays related to a principal or secondary diagnosis of an eating disorder from 2008-2009, compared to 1999 to 2000 (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb120.jsp). The increase was attributed to a 40% rise in secondary diagnoses for eating disorders. Over the decade, principal diagnoses of eating disorders fell by 1.8%. HCUP is a free online database of hospital inpatient stays.

During the decade, total costs for hospital stays involving eating disorders rose from $165 million in 1999-2000 to $277 million in 2008-2009; this was a 68% increase. The mean cost per discharge of a person with an eating disorder rose by 29% over the decade, from $7,300 to $9,400.

The HCUP report also revealed trends in hospitalizations by age and gender. Over the decade, hospitalizations involving eating disorders increased among all age groups. The greatest increases occurred among those 45 to 65 years of age (an 88% increase), followed by hospitalizations among patients younger than 12 years of age (a 72% increase). The majority of eating disorder inpatients were female. During 2008-2009, 88% of cases involved female patients, and 12% were male patients. The report also showed a 53% increase in hospitalizations for males with a principal diagnosis of an eating disorder, from 10% to 12% over the decade (see related article on males with eating disorders elsewhere in this issue). The average length of a hospital stay was about 8 days during both 1999-2000 and 2008-2009, and the inpatient death rate also did not change—it was 0.7% in both time periods.

Changes in Individual Diagnoses

Among specific diagnoses, changes in hospitalization rates varied widely. Hospitalizations for AN rose by 13%, those for bulimia nervosa fell by 14%, and cases of psychogenic vomiting fell by 18%. A major increase, 56%, occurred in “other/unspecified disorders,” which included cases of eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED). The report also provided information about serious secondary conditions among hospitalized eating disorders patients. The largest increase involved eating-disorder-related nutritional deficiencies and other nutritional, endocrine, and metabolic disorders, which showed a 129% increase. Acute renal or liver failure diagnoses rose by 127%; cardiac dysrhythmias among eating disorder patients declined by 39%; and menstrual disorders declined by 46%.

Children with Obesity

HCUP also recently published a statistical brief on hospitalizations of obese children reported between 2000 to 2009 (HCUP Kids’ Inpatient Database). In 2009, there were about 38,000 hospital stays; about 2% of these involved obesity among children aged 1 to 17 years. From 2000 to 2009, the rate of hospitalizations of children for obesity-related problems more than doubled, from 2.4 to 5.4 stays per 10,000 children. In 2009, the average cost of an obesity-related hospital stay was 24% higher than for a stay with no mention of obesity. In 2000, about 46% of obesity-related hospital stays for children 1 to 17 years of age were covered by private instance; by 2009 this decreased to 37%. Medicaid was the expected payer for 44% of all obesity-related hospital stays in 2000, but this increased to 54% in 2009. The most common principal diagnosis associated with obesity was mood disorder, which accounted for nearly 16% of all patients aged 1 to 17 years hospitalized with obesity.