[ { "phenotype_id": "PH891", "phenotype_version_id": 1861, "name": "Rheumatological 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": "2022-04-04T07:08:32.585571Z", "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": "2022-04-04T07:08:32.585596Z", "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": 2661, "concept_version_id": 6735, "concept_name": "Rheumatological Disease - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH891", "phenotype_version_id": 1861, "phenotype_name": "Rheumatological Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "2A42.00", "description": "O/E - ankle reflex abnormal", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "F371200", "description": "Polyneuropathy in rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "F396100", "description": "Myopathy due to disseminated lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "F396400", "description": "Myopathy due to rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "F396600", "description": "Myopathy due to scleroderma", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "G5yA.00", "description": "Rheumatoid carditis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "H570.00", "description": "Rheumatoid lung", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "H572.00", "description": "Lung disease with systemic sclerosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "H57y100", "description": "Lung disease with polymyositis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "H57y400", "description": "Lung disease with systemic lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K01x400", "description": "Nephrotic syndrome in systemic lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "K01x411", "description": "Lupus nephritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000.00", "description": "Systemic lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000000", "description": "Disseminated lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000100", "description": "Libman-Sacks disease", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000200", "description": "Drug-induced systemic lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000300", "description": "Systemic lupus erythematosus with organ or sys involv", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000400", "description": "Systemic lupus erythematosus with pericarditis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N000z00", "description": "Systemic lupus erythematosus NOS", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N001.00", "description": "Scleroderma", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N001000", "description": "Progressive systemic sclerosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N001.11", "description": "Acrosclerosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N001.12", "description": "Systemic sclerosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N004.00", "description": "Polymyositis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04..00", "description": "Rheumatoid arthritis and other inflammatory polyarthropathy", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040.00", "description": "Rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040200", "description": "Rheumatoid arthritis of shoulder", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040300", "description": "Rheumatoid arthritis of sternoclavicular joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040400", "description": "Rheumatoid arthritis of acromioclavicular joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040500", "description": "Rheumatoid arthritis of elbow", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040600", "description": "Rheumatoid arthritis of distal radio-ulnar joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040700", "description": "Rheumatoid arthritis of wrist", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040800", "description": "Rheumatoid arthritis of MCP joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040900", "description": "Rheumatoid arthritis of PIP joint of finger", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040A00", "description": "Rheumatoid arthritis of DIP joint of finger", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040B00", "description": "Rheumatoid arthritis of hip", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040C00", "description": "Rheumatoid arthritis of sacro-iliac joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040D00", "description": "Rheumatoid arthritis of knee", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040E00", "description": "Rheumatoid arthritis of tibio-fibular joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040F00", "description": "Rheumatoid arthritis of ankle", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040G00", "description": "Rheumatoid arthritis of subtalar joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040H00", "description": "Rheumatoid arthritis of talonavicular joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040J00", "description": "Rheumatoid arthritis of other tarsal joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040K00", "description": "Rheumatoid arthritis of 1st MTP joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040L00", "description": "Rheumatoid arthritis of lesser MTP joint", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040M00", "description": "Rheumatoid arthritis of IP joint of toe", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040P00", "description": "Seronegative rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N040T00", "description": "Flare of rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N041.00", "description": "Felty's syndrome", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N042100", "description": "Rheumatoid lung disease", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N047.00", "description": "Seropositive errosive rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04X.00", "description": "Seropositive rheumatoid arthritis, unspecified", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04y000", "description": "Rheumatoid lung", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04y011", "description": "Caplan's syndrome", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04y012", "description": "Fibrosing alveolitis associated with rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N04y111", "description": "Sero negative polyarthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N060.11", "description": "Endemic polyarthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N20..00", "description": "Polymyalgia rheumatica", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N200.00", "description": "Giant cell arteritis with polymyalgia rheumatica", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N231400", "description": "Polymyositis ossificans", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N240.00", "description": "Rheumatism and fibrositis unspecified", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N240000", "description": "Rheumatism unspecified", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N240200", "description": "Muscular rheumatism", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N240700", "description": "Hand rheumatism", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N240z00", "description": "Rheumatism or fibrositis NOS", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N2y..00", "description": "Other specified nonarticular rheumatism", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "N2z..00", "description": "Nonarticular rheumatism NOS", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu1000", "description": "[X]Rheumatoid arthritis+involvement/other organs or systems", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu1100", "description": "[X]Other seropositive rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu1200", "description": "[X]Other specified rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu1G00", "description": "[X]Seropositive rheumatoid arthritis, unspecified", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu4300", "description": "[X]Other forms of systemic lupus erythematosus", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } }, { "code": "Nyu4500", "description": "[X]Other forms of systemic sclerosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "Read", "Category": "diagnostic" } } ] }, { "concept_id": 2662, "concept_version_id": 6737, "concept_name": "Rheumatological Disease - Primary Care", "coding_system": { "id": 4, "name": "ICD10 codes", "description": "ICD10 Codes" }, "phenotype_id": "PH891", "phenotype_version_id": 1861, "phenotype_name": "Rheumatological Disease", "code_attribute_header": [ "Entity type", "Coding System (ICD-10 Read)", "Category" ], "codes": [ { "code": "D86", "description": "Sarcoidosis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "M05", "description": "Seropositive rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "M06", "description": "Other rheumatoid arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "M08", "description": "Juvenile arthritis", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "M09", "description": "Juvenile arthritis in disease classified elsewhere", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } }, { "code": "M30-M36", "description": "Systemic connective tissue disorders", "attributes": { "Entity type": "res69: rheumatological_disease", "Coding System (ICD-10 Read)": "ICD-10", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/06y9-f555", "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": 1861, "version_name": "Rheumatological Disease", "version_date": "2022-04-04T07:08:32.612074Z", "is_published": true, "is_latest": true } ] } ]