[ { "phenotype_id": "PH393", "phenotype_version_id": 786, "name": "Smoking", "definition": "PURPOSE:\n\nSelf-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves.\n\n\nMETHODS:\n\nDuring 2001-2013, a total of 385 general practices in England contributed data to the Clinical Practice Research Datalink with linkage to Office for National Statistics mortality records. We identified 30,017 persons aged 15 to 64 years with a recorded episode of self-harm. We estimated the relative risks of all-cause and cause-specific natural and unnatural mortality using a comparison cohort of 600,258 individuals matched on age, sex, and general practice.\n\n\nRESULTS:\n\nWe found an elevated risk of dying prematurely from any cause among the self-harm cohort, especially in the first year of follow-up (adjusted hazard ratio for that year, 3.6; 95% CI, 3.1-4.2). In particular, suicide risk was especially high during the first year (adjusted hazard ratio, 54.4; 95% CI, 34.3-86.3); although it declined sharply, it remained much higher than that in the comparison cohort. Large elevations of risk throughout the follow-up period were also observed for accidental, alcohol-related, and drug poisoning deaths. At 10 years of follow-up, cumulative incidence values were 6.5% (95% CI, 6.0%-7.1%) for allcause mortality and 1.3% (95% CI, 1.2%-1.5%) for suicide.\n\n\nCONCLUSIONS:\n\nPrimary care patients who have harmed themselves are at greatly increased risk of dying prematurely by natural and unnatural causes, and especially within a year of a first episode. These individuals visit clinicians at a relatively high frequency, which presents a clear opportunity for preventive action. Primary care patients with myriad comorbidities, including self-harming behavior, mental disorder, addictions, and physical illnesses, will require concerted, multipronged, multidisciplinary collaborative care approaches.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Matthew J Carr, Darren M Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb, Premature Death Among Primary Care Patients With a History of Self-Harm. Annals of Family Medicine, 15(3), 2017." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:17:13.121598Z", "author": "Matthew J Carr, Darren M Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T Webb", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:17:13.121627Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Lifestyle risk factor", "value": "4" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2013", "concept_information": [ { "concept_id": 1725, "concept_version_id": 4588, "concept_name": "Smoking - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH393", "phenotype_version_id": 786, "phenotype_name": "Smoking", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "137..00", "description": "Tobacco consumption", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1371.00", "description": "Never smoked tobacco", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137..11", "description": "Smoker - amount smoked", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1371.11", "description": "Non-smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1372.00", "description": "Trivial smoker - < 1 cig/day", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1372.11", "description": "Occasional smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1373.00", "description": "Light smoker - 1-9 cigs/day", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1374.00", "description": "Moderate smoker - 10-19 cigs/d", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1375.00", "description": "Heavy smoker - 20-39 cigs/day", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1376.00", "description": "Very heavy smoker - 40+cigs/d", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1377.00", "description": "Ex-trivial smoker (<1/day)", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1378.00", "description": "Ex-light smoker (1-9/day)", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1379.00", "description": "Ex-moderate smoker (10-19/day)", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137a.00", "description": "Pipe tobacco consumption", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137A.00", "description": "Ex-heavy smoker (20-39/day)", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137b.00", "description": "Ready to stop smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137B.00", "description": "Ex-very heavy smoker (40+/day)", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137c.00", "description": "Thinking about stopping smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137C.00", "description": "Keeps trying to stop smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137d.00", "description": "Not interested in stopping smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137D.00", "description": "Admitted tobacco cons untrue ?", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137e.00", "description": "Smoking restarted", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137E.00", "description": "Tobacco consumption unknown", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137F.00", "description": "Ex-smoker - amount unknown", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137G.00", "description": "Trying to give up smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137H.00", "description": "Pipe smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137I.00", "description": "Passive smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137j.00", "description": "Ex-cigarette smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137J.00", "description": "Cigar smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137K.00", "description": "Stopped smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137K000", "description": "Recently stopped smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137l.00", "description": "Ex roll-up cigarette smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137L.00", "description": "Current non-smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137m.00", "description": "Failed attempt to stop smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137M.00", "description": "Rolls own cigarettes", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137N.00", "description": "Ex pipe smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137O.00", "description": "Ex cigar smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137P.00", "description": "Cigarette smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137P.11", "description": "Smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Q.00", "description": "Smoking started", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Q.11", "description": "Smoking restarted", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137R.00", "description": "Current smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137S.00", "description": "Ex smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137T.00", "description": "Date ceased smoking", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137U.00", "description": "Not a passive smoker", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137V.00", "description": "Smoking reduced", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137W.00", "description": "Chews tobacco", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137X.00", "description": "Cigarette consumption", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Y.00", "description": "Cigar consumption", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "137Z.00", "description": "Tobacco consumption NOS", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8CAL.00", "description": "Smoking cessation advice", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H7i.00", "description": "Referral to smoking cessation advisor", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HkQ.00", "description": "Referral to NHS stop smoking service", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HTK.00", "description": "Referral to stop-smoking clinic", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8IAj.00", "description": "Smoking cessation advice declined", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9km..00", "description": "Ex-smoker annual review - enhanced services administration", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9km..11", "description": "Ex-smoker annual review", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9kn..00", "description": "Non-smoker annual review - enhanced services administration", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9kn..11", "description": "Non-smoker annual review", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9ko..00", "description": "Current smoker annual review - enhanced services admin", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9ko..11", "description": "Current smoker annual review", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9NS0200", "description": "Referral for smoking cessation service offered", "attributes": { "Entity type": "res41: smoking", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/tz8s-p756", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 786, "version_name": "Smoking", "version_date": "2021-10-06T16:17:13.148643Z", "is_published": true, "is_latest": true } ] } ]