[ { "phenotype_id": "PH890", "phenotype_version_id": 1859, "name": "Renal Disease", "definition": "Background:\n\nSelf-harm is a major risk factor for suicide, with older adults (older than 65 years) having reportedly greater suicidal intent than any other age group. With the aging population rising and paucity of research focus in this age group, the extent of the problem of self-harm needs to be established. In a primary care cohort of older adults we aimed to investigate the incidence of self-harm, subsequent clinical management, prevalence of mental and physical diagnoses, and unnatural-cause mortality risk, including suicide.\n\n\nMethods:\n\nThe UK Clinical Practice Research Datalink contains anonymised patient records from general practice that routinely capture clinical information pertaining to both primary and secondary care services. We identified 4124 adults aged 65 years and older with a self-harm episode ascertained from Read codes recorded during 2001–14. We calculated standardised incidence and in 2854 adults with at least 12 months follow-up examined the frequency of psychiatric referrals and prescription of psychotropic medication after self-harm. We estimated prevalence of mental and physical illness diagnoses before and after self-harm and, using Cox regression in a matched cohort, we examined cause-specific mortality risks.\n\n\nFindings:\n\nOverall incidence of self-harm in older adults aged 65 years and older was 4·1 per 10 000 person-years with stable gender-specific rates observed over the 13-year period. After self-harm, 335 (11·7%) of 2854 adults were referred to mental health services, 1692 (59·3%) were prescribed an antidepressant, and 336 (11·8%) were prescribed a tricyclic antidepressant (TCA). Having a diagnosed previous mental illness was twice as prevalent in the self-harm cohort as in the comparison cohort (prevalence ratio 2·10 [95% CI 2·03–2·17]) and with a previous physical health condition prevalence was 20% higher in the self-harm cohort compared to the comparison cohort (1·20 [1·17–1·23]). Adults from the self-harm cohort (n=2454) died from unnatural causes an estimated 20 times more frequently than the comparison cohort (n=48 921) during the first year. A markedly elevated risk of suicide (hazard ratio 145·4 [95% CI 53·9–392·3]) was observed in the self-harm cohort.\n\n\nInterpretation: \n\nWithin primary care, we have identified a group of older adults at high risk from unnatural death, particularly within the first year of self-harm. We have highlighted a high frequency of prescription of TCAs, known to be potentially fatally toxic in overdose. We emphasise the need for early intervention, careful alternative prescribing, and increased support when older adults consult after an episode of self-harm and with other health conditions.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft, Self-harm in a primary care cohort of older people incidence, clinical management, and risk of suicide and other causes of death. Psychiatry, 5, 2018." } ], "validation": "", "citation_requirements": "", "created": "2022-04-04T07:08:30.093965Z", "author": "Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2022-04-04T07:08:30.093990Z", "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": "ICD10 codes", "value": 4 }, { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/2001 - 31/12/2014", "concept_information": [ { "concept_id": 2659, "concept_version_id": 6731, "concept_name": "Renal Disease - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH890", "phenotype_version_id": 1859, "phenotype_name": "Renal Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "14D1.00", "description": "H/O: nephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1Z10.00", "description": "Chronic kidney disease stage 1", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1Z11.00", "description": "Chronic kidney disease stage 2", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1Z12.00", "description": "Chronic kidney disease stage 3", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1Z13.00", "description": "Chronic kidney disease stage 4", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "1Z14.00", "description": "Chronic kidney disease stage 5", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0...00", "description": "Nephritis, nephrosis and nephrotic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K001.00", "description": "Acute nephritis with lesions of necrotising glomerulitis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K012.00", "description": "Nephrotic syndrome+membranoproliferative glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K019.00", "description": "Nephrotic syn,diffuse mesangiocapillary glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02..00", "description": "Chronic glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K021.00", "description": "Chronic membranous glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02..11", "description": "Nephritis - chronic", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02..12", "description": "Nephropathy - chronic", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K022.00", "description": "Chronic membranoproliferative glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K023.00", "description": "Chronic rapidly progressive glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02y000", "description": "Chronic glomerulonephritis + diseases EC", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02y200", "description": "Chronic focal glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02y300", "description": "Chronic diffuse glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02yz00", "description": "Other chronic glomerulonephritis NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K02z.00", "description": "Chronic glomerulonephritis NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K03..00", "description": "Nephritis and nephropathy unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K03..11", "description": "Nephritis and nephropathy unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032.00", "description": "Membranoproliferative nephritis unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032000", "description": "Focal membranoproliferative glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032y00", "description": "Nephritis unsp+OS membranoprolif glomerulonephritis lesion", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032y13", "description": "Mesangioproliferative glomerulonephritis NEC", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032y14", "description": "Mesangiocapillary glomerulonephritis NEC", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K032z00", "description": "Nephritis unsp+membranoprolif glomerulonephritis lesion NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K034.00", "description": "Renal cortical necrosis unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K035.00", "description": "Renal medullary necrosis unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K041.00", "description": "Acute renal cortical necrosis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K042.00", "description": "Acute renal medullary necrosis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K04y.00", "description": "Other acute renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K04z.00", "description": "Acute renal failure NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K05..00", "description": "Chronic renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K050.00", "description": "End stage renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K06..00", "description": "Renal failure unspecified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K060.11", "description": "Impaired renal function", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080.00", "description": "Renal osteodystrophy", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080000", "description": "Phosphate-losing tubular disorders", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080100", "description": "Renal dwarfism", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080200", "description": "Renal infantilism", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080300", "description": "Renal rickets", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K080z00", "description": "Renal osteodystrophy NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K081.00", "description": "Nephrogenic diabetes insipidus", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K08y000", "description": "Hypokalaemic nephropathy", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K08yz00", "description": "Other impaired renal function disorder NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K08z.00", "description": "Impaired renal function disorder NOS", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0A3200", "description": "Chron nephritic syndrom difuse membranous glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0A3300", "description": "Chron neph syn difus mesangial prolifrtiv glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0A3500", "description": "Chronic neph syn difus mesangiocapillary glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0A3700", "description": "Chronic nephritic syn diffuse crescentic glomerulonephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K0A5500", "description": "[X]Heredtry nephrpthy NEC difus mesangiocapilry glomneph", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K100000", "description": "Chronic pyelonephritis without medullary necrosis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K100100", "description": "Chronic pyelonephritis with medullary necrosis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K101000", "description": "Acute pyelonephritis without medullary necrosis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Kyu2.00", "description": "[X]Renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Kyu2000", "description": "[X]Other acute renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Kyu2100", "description": "[X]Other chronic renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } } ] }, { "concept_id": 2660, "concept_version_id": 6733, "concept_name": "Renal Disease - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH890", "phenotype_version_id": 1859, "phenotype_name": "Renal Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "I12", "description": "Hypertensive renal disease", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "I13", "description": "Hypertensive heart and renal disease", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N00", "description": "Acute nephritic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N01", "description": "Rapidly progressive nephritic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N02", "description": "Recurrent and persistent haematuria", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N03", "description": "Chronic nephritic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N04", "description": "Nephrotic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N05", "description": "Unspecified nephritic syndrome", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N07", "description": "Herediatry nephropathy, not elsewhere classified", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N11", "description": "Chronic tubulo-interstitial nephritis", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N14", "description": "Drug- and heavy-metal-induced tubulo-interstitial and tubular conditions", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "N17-N19", "description": "Renal failure", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "Q61", "description": "Cystic kidney disease", "attributes": { "Entity type": "res69: renal_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/bfkw-sn32", "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": 1859, "version_name": "Renal Disease", "version_date": "2022-04-04T07:08:30.120251Z", "is_published": true, "is_latest": true } ] } ]