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Epidemiology of eating disorders in primary care in children and young people: a Clinical Practice Research Datalink study in England
  1. Sophie Wood1,2,
  2. Amanda Marchant1,
  3. Mark Allsopp3,4,
  4. Kathleen Wilkinson4,
  5. Jackie Bethel2,
  6. Hywel Jones2,
  7. Ann John1
  1. 1Population Psychiatry, Suicide and Informatics, Swansea University Medical School, Swansea, UK
  2. 2Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
  3. 3Child and Adolescent Psychiatry, Berkshire Healthcare NHS Foundation Trust, England, UK
  4. 4NCEPOD, London, UK
  1. Correspondence to Professor Ann John; a.john{at}


Objectives Examination of current temporal trends and clinical management patterns of eating disorders (ED) in primary care is lacking. We aimed to calculate annual incidence rates of EDs in primary care by age, sex and deprivation. We also explored the care received through referrals, psychotropic prescriptions and associated secondary care service use.

Participants and settings A retrospective electronic cohort study was conducted using the Clinical Practice Research Datalink in those aged 11–24 years between 2004 and 2014 in England (n=1 135 038).

Results A total of 4775 individuals with a first ever recorded ED diagnosis were identified. The crude incidence rate was 100.1 per 100 000 person years at risk (95% CI 97.2 to 102.9). Incidence rates were highest in females (189.3 per 100 000 person years, 95% CI 183.7 to 195.0, n=4336), 16–20 years of age (141.0 per 100 000 person years, 95% CI 135.4 to 146.9, n=2348) and individuals from the least deprived areas (115.8 per 100 000 person years (95% CI 109.3 to 122.5, n=1203). Incidence rates decreased across the study period (incidence rate ratio (IRR) 0.6, 95% CI 0.5 to 0.8), particularly for individuals with bulimia nervosa (IRR 0.5, 95% CI 0.3 to 0.7) and from the most deprived areas (IRR 0.5, 95% CI 0.4 to 0.7). A total of 17.4% (95% CI 16.3 to 18.5, n=831) of first ever recorded ED cases were referred from primary to secondary care. 27.1% (95% CI 25.9 to 28.4, n=1294) of individuals had an inpatient admission 6 months before or 12 months after an incident ED diagnosis and 53.4% (95% CI 52.0 to 54.9, n=2550) had an outpatient attendance. Antidepressants were the most commonly prescribed psychotropic medication.

Conclusions New ED presentations in primary care are reducing. Understanding the cause of this decrease (coding behaviours, changes in help-seeking or a genuine reduction in new cases) is important to plan services, allocate resources and deliver effective care.

  • children and young people
  • CPRD
  • incidence rates
  • eating disorders
  • prescribing

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  • Contributors AJ, KW, MA conceived the study; all authors designed the study; AJ supervised the study; SW, AM, HJ, JB analysed the data; AJ, SW wrote the initial draft and all authors commented on the manuscript.

  • Funding This study was funded by MQ through the Adolescent Data Platform. AJ and HJ are supported by The Farr Institute CIPHER, funded by Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute of Health Research, the National Institute for Social Care and Health Research (Welsh Assembly Government), the Chief Scientist Office (Scottish Government Health Directorates), and the Wellcome Trust, (MRC Grant No: MR/K006525/1).

  • Disclaimer The interpretation and conclusions contained in this study are those of the author/s alone.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained under licence from the Independant Scientific Advisory Committee of the UK Medicines and Healthcare products Regulatory Agency.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data analysed for this study were obtained under institutional licence from the Clinical Practice Research Datalink ( Data are not available for sharing but can be applied for through the CPRD. Relevant data are also available in the paper and its Supporting Information files.

  • Press Release Once we have a publication date we plan to write a press release and an article for the Conversation

  • Patient consent for publication Permissions granted to CPRD of anonymised routine data

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