[ { "phenotype_id": "PH863", "phenotype_version_id": 1805, "name": "Abdominal Pain", "definition": "Background: \n\nStudies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.\n\n\nMethods: \n\nThis cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018. It included people aged 18–99 years with depression first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine (5081), a different SSRI (15,032), amitriptyline (3905), or venlafaxine (1580). Follow-up was from starting to stopping the second antidepressant, with a 6-month wash-out window, censoring at the end of CPRD follow-up or 30 November 2018. Age-sex standardised rates of all-cause mortality and death due to circulatory system disease, cancer, or respiratory system disease were calculated. Survival analyses were performed, accounting for baseline characteristics using inverse probability of treatment weighting.\n\n\nResults: \n\nThe cohort contained 25,598 people (median age 41 years). The mirtazapine group had the highest standardised mortality rate, with an additional 7.8 (95% confidence interval (CI) 5.9–9.7) deaths/1000 person-years compared to the SSRI group. Within 2 years of follow-up, the risk of all-cause mortality was statistically significantly higher in the mirtazapine group than in the SSRI group (weighted hazard ratio (HR) 1.62, 95% CI 1.28–2.06). No significant difference was found between the mirtazapine group and the amitriptyline (HR 1.18, 95% CI 0.85–1.63) or venlafaxine (HR 1.11, 95% CI 0.60–2.05) groups. After 2 years, the risk was significantly higher in the mirtazapine group compared to the SSRI (HR 1.51, 95% CI 1.04–2.19), amitriptyline (HR 2.59, 95% CI 1.38–4.86), and venlafaxine (HR 2.35, 95% CI 1.02–5.44) groups. The risks of death due to cancer (HR 1.74, 95% CI 1.06–2.85) and respiratory system disease (HR 1.72, 95% CI 1.07–2.77) were significantly higher in the mirtazapine than in the SSRI group.\n\n\nConclusions: \n\nMortality was higher in people prescribed mirtazapine than people prescribed a second SSRI, possibly reflecting residual differences in other risk factors between the groups. Identifying these potential health risks when prescribing mirtazapine may help reduce the risk of mortality.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland, The risk of all-cause and cause-specific mortality in people prescribed mirtazapine an active comparator cohort study using electronic health records. BMC Medicine, 20(43), 2022." } ], "validation": "", "citation_requirements": "", "created": "2022-04-04T07:07:08.084716Z", "author": "Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2022-04-04T07:07:08.084741Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "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": "01/01/2005 - 30/11/2018", "concept_information": [ { "concept_id": 2613, "concept_version_id": 6639, "concept_name": "Abdominal Pain - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH863", "phenotype_version_id": 1805, "phenotype_name": "Abdominal Pain", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "14CF.00", "description": "history of irritable bowel syndrome", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "196..00", "description": "type of git pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "196..11", "description": "abdominal pain type", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "196..12", "description": "type of git pain - symptom", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1962", "description": "colicky abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1963", "description": "non-colicky abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1964", "description": "shoulder pain from abdomen", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1969", "description": "abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1969000", "description": "abdominal wall pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "196A.00", "description": "hunger pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "196Z.00", "description": "type of git pain nos", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197..00", "description": "site of git pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1971", "description": "central abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197..11", "description": "flank pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197..12", "description": "iliac fossa pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197..13", "description": "site of abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197..14", "description": "subcostal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1972", "description": "epigastric pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1973", "description": "left subcostal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1974", "description": "right subcostal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1975", "description": "left flank pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1976", "description": "right flank pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1977", "description": "right iliac fossa pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1978", "description": "left iliac fossa pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "1979", "description": "suprapubic pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197A.00", "description": "generalised abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197A.11", "description": "general abdominal pain-symptom", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197B.00", "description": "upper abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197C.00", "description": "lower abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197D.00", "description": "right upper quadrant pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "197Z.00", "description": "site of git pain nos", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C..00", "description": "o/e - abdo. pain on palpation", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C..11", "description": "o/e - epigastric pain on palp.", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C..12", "description": "o/e - iliac pain on palpation", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C..13", "description": "o/e - lumbar pain on palpation", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C..14", "description": "o/e - umbilical pain on palp.", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C2.00", "description": "o/e - abd.pain-r.hypochondrium", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C3.00", "description": "o/e - abd. pain - epigastrium", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C4.00", "description": "o/e - abd.pain-l.hypochondrium", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C5.00", "description": "o/e - abd. pain - r.lumbar", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C6.00", "description": "o/e - abd. pain - umbilical", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C7.00", "description": "o/e - abd. pain - l.lumbar", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C8.00", "description": "o/e - abd. pain - r.iliac", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25C9.00", "description": "o/e - abd. pain - hypogastrium", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25CA.00", "description": "o/e - abd. pain - l.iliac", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "25CZ.00", "description": "o/e -abd.pain on palpation nos", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "J521.00", "description": "irritable colon - irritable bowel syndrome", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "J521000", "description": "irritable bowel syndrome with diarrhoea", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "J521100", "description": "irritable bowel syndrome characterised by constipation", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "J521.11", "description": "irritable bowel syndrome", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "J521.13", "description": "spastic colon", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R073200", "description": "[d]gas pain (abdominal)", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090.00", "description": "[d]abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090500", "description": "[d]epigastric pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090600", "description": "[d]umbilical pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090700", "description": "[d]hypochondrial pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090800", "description": "[d]suprapubic pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090900", "description": "[d]pain in right iliac fossa", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090A00", "description": "[d]pain in left iliac fossa", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090B00", "description": "[d]groin pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090C00", "description": "[d]loin pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090E00", "description": "[d]recurrent acute abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090G00", "description": "[d]pelvic and perineal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090G11", "description": "[d] pelvic pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090G12", "description": "[d] perineal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090H00", "description": "[d]upper abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090J00", "description": "[d]right upper quadrant pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090K00", "description": "[d]left upper quadrant pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090L00", "description": "[d]left lower quadrant pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090M00", "description": "[d]right lower quadrant pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090N00", "description": "[d]nonspecific abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090P00", "description": "[d]functional abdominal pain syndrome", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090y00", "description": "[d]other specified abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "R090z00", "description": "[d]abdominal pain nos", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Ryu1000", "description": "[x]pain localized to other parts of lower abdomen", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Ryu1100", "description": "[x]other and unspecified abdominal pain", "attributes": { "Entity type": "res176: Abdominal pain", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/evm4-1z36", "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": 1805, "version_name": "Abdominal Pain", "version_date": "2022-04-04T07:07:08.115264Z", "is_published": true, "is_latest": true } ] } ]