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register hereBACKGROUND: 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.

背景：自闭症，注意力缺陷多动障碍（ADHD）和性别烦躁不安（GD）的发病率不仅在普通人群中上升，而且在儿童，青少年和患有饮食障碍（EDs）的年轻人中尤其如此。虽然在新型冠状病毒大流行期间ED率有所上升，但自闭症，多动症和GD并存的趋势尚未通过大型电子病历数据进行详细或大规模调查。

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OBJECTIVES: 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.

目的：调查在新型冠状病毒肺炎大流行之前和期间，患有EDs的儿童，青少年和年轻人中自闭症，多动症和GD并存率的趋势。

METHODS: 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.

方法：我们使用了一个未识别的多国电子健康记录数据库（TriNetX），在2017年至2022年间，有48558名年龄在5-26岁之间的人被诊断出至少两次患有进食障碍（EDs）。主要预测变量区分了每个人的指数（首次）ED诊断年份（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..

2020-2022年）。主要结果变量是每位患者第一次ED诊断后一年内自闭症，ADHD和GD的新并发精神病诊断率。我们应用倾向评分匹配的多变量逻辑回归来比较2017-2019年和2020-2022年之间的主要结果。。

RESULTS: 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.

结果：我们的分析包括2017-2019年诊断为EDs的17445人（自闭症8%，ADHD 13.5%，GD 1.9%）和2020-2022年诊断为EDs的31113人（自闭症8%，ADHD 14.6%，GD 3.2%）。在1:1倾向评分匹配后，2017-2019年队列中的17202个人与2020-2022年队列中的同龄人进行了匹配。

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. .

与2017-2019年队列相比，2020-2022年确诊的患者在EDs指数诊断后的365天内，自闭症，ADHD和GD诊断的几率分别增加了19%（aOR[95%CI]=1.19[1.07-1.33]），25%（aOR=1.25[1.04-1.49]）和36%（aOR=1.36[1.07-1.74]）。

DISCUSSION: 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..

讨论：与大流行前2017-2019队列相比，大流行后2020-2022队列中ED患者的自闭症，ADHD和GD发生率显着更高，即使在控制了同时发生的精神病诊断的基线水平之后。这些发现揭示了我们目前对COVID-19可能影响儿童，青少年和年轻人EDs，自闭症，ADHD和GD发病和临床过程的全部方式的理解存在重大差距。。