Gender inequalities and the burden of anorexia and bulimia in Europe, 1990–2023: findings from the Global Burden of Disease Study 2023
G. Castelpietra, L. Monasta, G. ZamagniIntroduction
Eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN), are severe mental health conditions affecting physical and psychosocial health. Structural gender inequality may shape the burden of EDs across sexes and regions.
Objectives
We aimed to quantify the burden of EDs among young males and females in Europe using GBD 2023 estimates and to explore its association with the Gender Inequality Index (GII). Quantifying the burden of EDs in terms of YLDs and examining their implications for health systems can generate essential evidence to guide public health priorities, improve recognition and care, and foster more equitable and effective responses
Methods
We analyzed Global Burden of Disease Study 2023 estimates to assess the relationship between gender inequality and ED burden in Europe. Years Lived with Disability (YLD) for AN and BN were extracted by sex and five-year age groups (10–39 years) from 1990–2023 across 35 countries.
Gender inequality was measured using the GII. Mixed linear regression was applied with year, age group, sex, GII, and their interactions as fixed effects, and country and year as random intercept and slope, respectively.
Results
GII showed considerable variation across Western, Central, and Eastern Europe in 2023, as did YLDs for AN and BN (Figure 1). YLDs of both AN and BN increased from 1990 to 2023 across most countries and age groups, with females consistently experiencing the highest burden (Figure 2 and 3). For AN, higher levels of GII were significantly associated with greater YLD rates in both males (β = 29.28; 95% CI: 22.2 to 36.4) and females (β = 85.3; 95% CI: 42.1 to 128.6), with a stronger effect for females. For BN, GII was inversely associated with YLDs among males (β = –645.6; 95% CI: –732.8 to –558.3), while a positive association was found in females (β = 22 794.7; 95% CI: 659.1 to 930.2).
Image 1: Long description.