Primary care use among adults with eating disorders in England: a population-based cohort study using electronic health records.

Abstract

To examine primary care contacts among individuals with eating disorders (EDs) and assess differences across diagnoses and ethnic backgrounds. Matched cohort study using retrospective primary care data. Primary care electronic health records from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) covering 1 January 2010 to 31 December 2023. 46 473 individuals aged 18-65 years, with a recorded ED diagnosis or a referral to ED services, matched by age, sex and practice location (ratio 1:3) to 145 286 individuals without an ED. The primary outcome was the number of primary care contacts in 24 months prior to ED diagnosis or referral to ED specialist service. Secondary outcomes examined whether ethnicity impacted likelihood of referral to specialist ED services. Most individuals had a diagnosis of anorexia nervosa (43.0%), followed by bulimia nervosa (13.8%) and other specified feeding and ED (6.6%). 40.6% were aged 18-25 years, 79.5% were female and ethnicity was predominantly White (83.7%), with smaller proportions Asian (6.3%) and Black (3.4%). Compared with non-ED controls, cases had approximately double the rate of primary care contacts (incidence rate ratio (IRR)=1.96, 95% CI 1.94 to 1.98). Elevated contact rates were observed across all ED diagnostic groups, with IRRs ranging from 1.78 (95% CI 1.75 to 1.82) for anorexia nervosa to 2.45 (95% CI 2.09 to 2.88) for avoidant/restrictive food intake disorder (all p<0.001). Contact rates were significantly lower across all minoritised ethnic groups compared with White individuals. Referral odds were significantly lower among Asian (OR=0.78, 95% CI 0.65 to 0.94) and Black patients (OR=0.56, 95% CI 0.41 to 0.79). There is a need to increase ED awareness within minoritised communities, alongside culturally inclusive primary care adaptations to support help-seeking for EDs. Targeted education for clinicians and patients in primary care may also improve screening and recognition of EDs across diverse presentations and communities, facilitating access to timely, evidence-based care. The dataset from this study is held securely at the Medicines and Healthcare products Regulatory Agency. Access may be granted on completing a data request. The CPRD Ethnicity Record sources underlying data from HES and primary care data copyright 2025, re-used with the permission of The Health & Social Care Information Centre.