■自闭症的发病率,注意缺陷/多动障碍(ADHD),性别焦虑(GD)不仅在普通人群中上升,但尤其是在儿童中,青少年,和患有饮食失调(ED)的年轻人。虽然在COVID大流行期间ED率有所上升,同时发生自闭症的趋势,多动症,和GD尚未通过大型电子病历数据进行详细或大规模的调查。
■为了调查自闭症并发率的趋势,多动症,儿童中的GD,青少年,以及在COVID-19大流行之前和期间几年患有ED的年轻人。
■我们使用了一个去识别的跨国电子健康记录数据库(TriNetX),在2017年至2022年期间,有48,558名5-26岁的人被诊断患有饮食失调(ED)至少两次。主要预测变量在每个人的指数(第一次)ED诊断的年份(2017-2019年与2020-2022年)。主要结果变量是新的同时发生的自闭症精神病诊断的比率,多动症,和GD在每个患者的第一次ED诊断后的一年。我们应用倾向得分匹配的多变量逻辑回归比较2017-2019年和2020-2022年的主要结果。
■我们的分析包括2017-2019年被诊断患有ED的17445人(8%自闭症,13.5%多动症,1.9%GD)和31,113例2020-2022年诊断为ED(8%自闭症,14.6%多动症,3.2%GD)。1:1倾向评分匹配后,2017-2019年队列中的17,202人与2020-2022年队列的同龄人相匹配。2020-2022年确诊的患者为19%(aOR[95CI]=1.19[1.07-1.33]),25%(aOR=1.25[1.04-1.49]),自闭症的几率增加了36%(aOR=1.36[1.07-1.74]),多动症,和GD诊断,分别,在索引ED诊断后的365天内,与2017-2019年队列相比。
■自闭症的发生率,多动症,与大流行前2017-2019年队列相比,大流行后2020-2022年队列中ED患者的GD明显更高,即使控制了同时发生的精神病诊断的基线水平。这些发现揭示了我们目前对COVID-19可能影响ED发病和临床过程的总体方式的理解存在重大差距,自闭症,多动症,儿童中的GD,青少年,和年轻人。
UNASSIGNED: Incidence rates of autism, attention-deficit/hyperactivity disorder (ADHD), and gender dysphoria (GD) are rising not only in the general population, but particularly among children, adolescents, and young adults with eating disorders (EDs). While ED rates have risen during the COVID pandemic, trends in co-occurring autism, ADHD, and GD have yet to be investigated in detail or at scale by way of large electronic medical record data.
UNASSIGNED: To investigate trends in rates of co-occurring autism, ADHD, and GD among children, adolescents, and young adults with EDs in years prior to and during the COVID-19 pandemic.
UNASSIGNED: We utilized a de-identified multinational electronic health records database (TriNetX) with 48,558 individuals aged 5-26 diagnosed with eating disorders (EDs) at least twice between 2017 and 2022. The primary predictor variable differentiated between the years of each person\'s index (first) ED diagnosis (2017-2019 vs. 2020-2022). The primary outcome variable was the rate of new co-occurring psychiatric diagnoses of autism, ADHD, and GD in the year following each patient\'s first ED diagnosis. We applied propensity score-matched multivariable logistic regressions to compare primary outcomes between 2017-2019 and 2020-2022.
UNASSIGNED: Our analysis included 17,445 individuals diagnosed with EDs in 2017-2019 (8% autism, 13.5% ADHD, 1.9% GD) and 31,113 diagnosed with EDs in 2020-2022 (8% autism, 14.6% ADHD, 3.2% GD). After 1:1 propensity score matching, 17,202 individuals from the 2017-2019 cohort were matched to peers mirroring the 2020-2022 cohort. Those diagnosed in 2020-2022 showed a 19% (aOR[95%CI]=1.19[1.07-1.33]), 25% (aOR=1.25[1.04-1.49]), and 36% (aOR=1.36[1.07-1.74]) increase in odds for autism, ADHD, and GD diagnoses, respectively, within the 365 days after the index EDs diagnosis, compared to the 2017-2019 cohort.
UNASSIGNED: Rates of autism, ADHD, and GD are significantly higher in individuals with ED in the post-pandemic 2020-2022 cohort in comparison to the pre-pandemic 2017-2019 cohort, even after controlling for baseline levels of co-occurring psychiatric diagnoses. Such findings reveal a critical gap in our current understanding of the totality of ways in which COVID-19 may have impacted the onset and clinical course of EDs, autism, ADHD, and GD among children, adolescents, and young adults.