Objective:

Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects.

Methods:

A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs).

Results:

For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs.

Conclusions:

SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.

中文翻译：

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酒精和其他药物使用障碍对饮食失调患者死亡率的影响：一项基于全国登记的回顾性队列研究

 客观的：

目前缺乏关于不同类型的物质使用障碍 (SUD) 对所有饮食失调中死亡率过高的影响的研究。作者与匹配的对照受试者相比，评估了酒精使用障碍和其他 SUD 与神经性厌食症、神经性贪食症和不明饮食障碍患者死亡率的关联。

 方法：

使用丹麦全国登记册进行了一项回顾性队列研究。该研究包括 20,759 名饮食失调患者和 83,036 名匹配的对照受试者。计算风险比以比较饮食失调患者和对照受试者之间的全因死亡风险，无论是否有终生 SUD 诊断（滥用或依赖酒精、大麻或硬性药物）。

 结果：

对于患有每种类型饮食失调的患者，在滥用酒精和/或大麻的患者中，相对于没有 SUD 的对照受试者，观察到全因死亡的风险更高（调整神经性厌食症、神经性贪食症和未特指饮食失调的风险比）患者分别为 11.28 [95% CI=7.01, 18.16]、5.86 [95% CI=3.37, 10.1] 和 10.86 [95% CI=6.74, 17.50]），或单独使用硬性药物或与酒精和酒精合用与未使用大麻的患者相比（调整后的风险比分别为 22.34 [95% CI=15.13, 33.00]、11.43 [95% CI=7.14, 18.28] 和 15.53 [95% CI=10.15, 23.78]） SUD（调整后的风险比分别为 3.21 [95% CI=2.43, 4.23]、1.24 [95% CI=0.88, 1.77] 和 4.75 [95% CI=3.57, 6.31]）。相对于未服用 SUD 的对照受试者，服用 SUD 的对照受试者也表现出较高的全因死亡风险，尽管程度比服用 SUD 的饮食失调患者要低得多。

 结论：

SUD 对饮食失调患者的死亡率过高具有累加效应。因此，预防和治疗该患者群体的 SUD 对于降低死亡率至关重要。