Social Disparity and Treatment-Seeking in Eating Disorders During Childhood and Adolescence: A Nationwide Population-Based Cohort Study

Objective: Advantaged socioeconomic circumstances are linked to a higher risk of diagnosed eating disorders (EDs), but evidence on non-diagnosed cases, individuals reporting ED symp-toms without formal diagnosis, remains limited, suggesting detection and treatment-seeking barriers.In this study, we assessed associations between socioeconomic circumstances and clinically diagnosed and nondiagnosed EDs in childhood and adolescence.Method: This study used data from the Danish National Birth Cohort, linking registry-based diagnosed EDs (ages 6-18) with self-reported ED symptoms at age 18.Data included 523,148 individuals born in Denmark between 1996-2003, with 44,552 providing infor-mation on self-reported ED symptoms used to classify non-diagnosed EDs.Socioeconomic indicators, including parental education and household income at age 6, were analyzed using quasi-Poisson and multinomial logistic regression to estimate incidence rate ratios (IRRs) and relative risk ratios (RRRs).Results: Diagnosed EDs were more common among individuals with higher parental educa-tion, following a stepwise pattern.Compared to short education (~12 years), long education (~17-20 years) was associated with higher risk (IRR = 1.35, 95% CI: 1.21-1.52),while basic education (~10 years) was linked to lower risk (IRR = 0.70, 95% CI: 0.59-0.83).The pattern reversed for non-diagnosed EDs, with individuals whose parents had basic education show-ing a higher risk (RRR = 2.19, 95% CI: 1.83-2.63)compared to short education.No clear pattern was observed for household income. Conclusion:This study highlights socioeconomic disparities in ED diagnosis and treatment.Individuals from educationally advantaged backgrounds were more likely to receive a diag-nosis, whereas those from educationally disadvantaged backgrounds had a higher risk of non-diagnosed EDs.