Beyond the COVID-19 Surge: Divergent Postpandemic Trends in Hospitalizations for Anorexia Nervosa at Two Canadian Tertiary Pediatric Hospitals.

PURPOSE: To assess annual number of pediatric hospitalizations with anorexia nervosa (AN) as the most responsible discharge diagnosis before and after the COVID-19 pandemic at two Canadian tertiary pediatric eating disorder programs: Alberta Children's Hospital (ACH; Calgary, Alberta) and the Hospital for Sick Children (SickKids; Toronto, Ontario).

METHODS

We conducted a population-based analysis of annual hospitalizations for AN among those aged 7-18 years at ACH and SickKids from March 11, 2014, to March 10, 2025, using Discharge Abstract Database data. Annual discharge counts were analyzed by site using linear regression to compare pre- and post-COVID-19 trends, with outcomes and analyses defined a priori based on early pandemic evidence, before updated data were requested or analyzed.

RESULTS

Over the study period, discharges totaled 334 at ACH and 1,101 at SickKids, with no significant differences in age or sex distributions before versus after pandemic onset at either site. At ACH, the best-fitting model showed a significant steep increase in hospitalizations following pandemic onset with no change in prepandemic or postpandemic trends, resulting in elevated discharge counts over time (p < .001). In contrast, SickKids data were best explained by differing prepandemic and postpandemic slopes, reflecting an initial pandemic-associated increase followed by a decline toward prepandemic levels. In the final year, discharge counts at ACH were more than three-fold higher than prepandemic levels, whereas counts at SickKids returned to baseline (p < .001).

DISCUSSION: Postpandemic recovery in pediatric AN hospitalizations was not uniform, underscoring the need to consider regional system factors and institutional context when interpreting trends.