{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:34:26Z","timestamp":1792614866927,"version":"4.5.0"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi231342-4\"><jats:title>Importance<\/jats:title><jats:p>Understanding the evolving characteristics of pediatric patients hospitalized for eating disorders is important to ensure that services and treatments align with patient needs.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-5\"><jats:title>Objective<\/jats:title><jats:p>To examine temporal trends in the rates of hospitalizations for pediatric eating disorders by clinical and demographic characteristics in Ontario, Canada, over a 17-year period.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This population-based, repeated, cross-sectional study used linked health administrative and demographic databases in Ontario, Canada, to identify individuals aged 5 to 17 years hospitalized with eating disorder diagnoses from April 1, 2002, to March 31, 2020. Data analyses were performed from May 2021 to June 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-7\"><jats:title>Exposure<\/jats:title><jats:p>Fiscal year (April 1-March 31) of eating disorder hospitalization.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Outcomes of interest were absolute and relative changes in pediatric eating disorder hospitalization rates overall and stratified by patient sex, age groups, and eating disorder diagnostic groups.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-9\"><jats:title>Results<\/jats:title><jats:p>Over the study period, there were 11\u202f654 pediatric eating disorder hospitalizations, of which 5268 (45.2%) were for anorexia nervosa and 1374 (11.8%) were for bulimia nervosa. There were a total of 10\u202f648 hospitalizations (91.4%) among female patients, and the median (IQR) age was 15.0 (14-0-16.0) years. Hospitalization rates increased 139% from 2002 to 2019, from 2.0 per 10\u202f000 population to 4.8 per 10\u202f000 population. The largest relative changes were observed among male patients (416%; from 0.2 per 10\u202f000 population to 1.1 per 10\u202f000 population), individuals aged 12 to 14 years (196%; from 2.2 per 10\u202f000 population to 6.6 per 10\u202f000 population), and individuals with eating disorders other than anorexia or bulimia nervosa (255%; from 0.6 per 10\u202f000 population to 2.1 per 10\u202f000 population). Male patients, younger adolescents, and individuals with other eating disorders also represented larger proportions of hospitalizations by fiscal 2019.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi231342-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this cross-sectional study of eating disorder hospitalizations, pediatric hospitalizations increased over time, particularly among populations traditionally considered atypical. Existing eating disorder programs must adapt to accommodate changing patient presentations and increased volumes to ensure effective care delivery.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.46012","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T16:01:08Z","timestamp":1701705668000},"page":"e2346012","source":"Crossref","is-referenced-by-count":16,"title":["Pediatric Patients Hospitalized With Eating Disorders in Ontario, Canada, Over Time"],"prefix":"10.1001","volume":"6","author":[{"given":"Sarah","family":"Smith","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"ICES, Toronto, Canada"},{"name":"Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Charach","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada"},{"name":"Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada"},{"name":"Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"To","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"ICES, Toronto, Canada"},{"name":"Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alene","family":"Toulany","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Canada"},{"name":"ICES, Toronto, Canada"},{"name":"Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada"},{"name":"Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada"},{"name":"Edwin S. 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Psychiatry"},{"issue":"6","key":"zoi231342r3","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1017\/S0033291719000898","article-title":"DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance.","volume":"50","author":"Mitchison","year":"2020","journal-title":"Psychol Med"},{"key":"zoi231342r4","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1002\/eat.20118","article-title":"Medical complications in adolescents with anorexia nervosa: a review of the literature.","volume":"37","author":"Katzman","year":"2005","journal-title":"Int J Eat Disord"},{"issue":"2","key":"zoi231342r5","doi-asserted-by":"crossref","first-page":"E192","DOI":"10.9778\/cmajo.20140086","article-title":"Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives.","volume":"3","author":"Toulany","year":"2015","journal-title":"CMAJ 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individuals with eating disorders using health administrative data.","volume":"65","author":"Kurdyak","year":"2020","journal-title":"Can J Psychiatry"},{"issue":"6","key":"zoi231342r32","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.","volume":"38","author":"Austin","year":"2009","journal-title":"Commun Stat Simul Comput"},{"issue":"5","key":"zoi231342r33","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-002646","article-title":"The incidence of eating disorders in the UK in 2000-2009: findings from the General Practice Research Database.","volume":"3","author":"Micali","year":"2013","journal-title":"BMJ Open"},{"issue":"2","key":"zoi231342r35","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1177\/0706743715621254","article-title":"Mental health service use among children and youth in 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study.","volume":"4","author":"R\u00e4is\u00e4nen","year":"2014","journal-title":"BMJ Open"},{"issue":"1","key":"zoi231342r40","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/erv.2695","article-title":"Therapist adherence to family-based treatment for adolescents with anorexia nervosa: a multi-site exploratory study.","volume":"28","author":"Dimitropoulos","year":"2020","journal-title":"Eur Eat Disord Rev"},{"key":"zoi231342r12","volume-title":"Healthcare Cost and Utilization Project (HCUP) Statistical Briefs","author":"Zhao","year":"2006"},{"key":"zoi231342r27","volume-title":"Diagnostic and Statistical Manual of Mental Disorders.","author":"American Psychiatric Association","year":"1994","edition":"4th ed"},{"key":"zoi231342r28","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th 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Working with ICES data. Accessed June 2, 2022. https:\/\/www.ices.on.ca\/use-ices-data\/working-with-ices-data\/"},{"key":"zoi231342r26","unstructured":"Statistics Canada. CMA and CA: detailed definition. Accessed June 2, 2022. https:\/\/www150.statcan.gc.ca\/n1\/pub\/92-195-x\/2011001\/geo\/cma-rmr\/def-eng.htm"},{"key":"zoi231342r30","unstructured":"Intellihealth. Welcome to Intellihealth. Accessed June 2, 2022. https:\/\/intellihealth.moh.gov.on.ca\/"},{"key":"zoi231342r31","unstructured":"Statistic Canada. Distributions of household economic accounts, number of households, by income quintile and by socio-demographic characteristic. Accessed June 2, 2022. https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=3610010101"},{"key":"zoi231342r37","unstructured":"Mental health and addictions\u2014expanding supports for Ontarians. News release. Government of Ontario. January 25, 2017. 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