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Anxiolytic Hypnotic

Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft

Type
Drug
ID
PH466
Version ID
932
Data Sources
Valid event data range
01/01/1998 - 31/03/2014
Sex
Female, Male
Agreement Date
2018-04-09
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Importance:

People with epilepsy are at increased risk of mortality, but, to date, the cause-specific risks of all unnatural causes have not been reported.

Objective:

To estimate cause-specific unnatural mortality risks in people with epilepsy and to identify the medication types involved in poisoning deaths.

Design, Setting, and Participants:

This population-based cohort study used 2 electronic primary care data sets linked to hospitalization and mortality records, the Clinical Practice Research Datalink (CPRD) in England (from January 1, 1998, to March 31, 2014) and the Secure Anonymised Information Linkage (SAIL) Databank in Wales (from January 1, 2001, to December 31, 2014). Each person with epilepsy was matched on age (within 2 years), sex, and general practice with up to 20 individuals without epilepsy. Unnatural mortality was determined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records. Hazard ratios (HRs) were estimated in each data set using a stratified Cox proportional hazards model, and meta-analyses were conducted using DerSimonian and Laird random-effects models. The analysis was performed from January 5, 2016, to November 16, 2017.

Exposures:

People with epilepsy were identified using primary care epilepsy diagnoses and associated antiepileptic drug prescriptions.

Main Outcomes and Measures:

Hazard ratios (HRs) for unnatural mortality and the frequency of each involved medication type estimated as a percentage of all medication poisoning deaths.

Results:

In total, 44678 individuals in the CPRD and 14 051 individuals in the SAIL Databank were identified in the prevalent epilepsy cohorts, and 891 429 (CPRD) and 279 365 (SAIL) individuals were identified in the comparison cohorts. In both data sets, 51% of the epilepsy and comparison cohorts were male, and the median age at entry was 40 years (interquartile range, 25-60 years) in the CPRD cohorts and 43 years (interquartile range, 24-64 years) in the SAIL cohorts. People with epilepsy were significantly more likely to die of any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48) or suicide (HR, 2.15; 95% CI, 1.51-3.07) than people in the comparison cohort. Particularly large risk increases were observed in the epilepsy cohorts for unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53). Opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medication (32.3% [95% CI, 20.9%-45.3%)] were more commonly involved than antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]) in poisoning deaths in people with epilepsy.

Conclusions and Relevance:

Compared with people without epilepsy, people with epilepsy are at increased risk of unnatural death and thus should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

Publications

  • Hayley C Gorton, Roger T Webb, Mathew J Carr, Marcos Delpozo-Banos, Ann John, Darren M Ashcroft, Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurology, 75(8), 929-038, 2018.

Clinical Code List

Rows: 37
Code Description Entity type Category Coding System (Read)
d1... hypnotics res55: anxiolytic_hypnotic drug Read
d11.. chloral hydrate res55: anxiolytic_hypnotic drug Read
d12.. clomethiazole ed. [hypnot] res55: anxiolytic_hypnotic drug Read
d13.. *dichloralphenazone res55: anxiolytic_hypnotic drug Read
d14.. *flunitrazepam res55: anxiolytic_hypnotic drug Read
d15.. flurazepam res55: anxiolytic_hypnotic drug Read
d16.. loprazolam res55: anxiolytic_hypnotic drug Read
d17.. lormetazepam res55: anxiolytic_hypnotic drug Read
d18.. nitrazepam res55: anxiolytic_hypnotic drug Read
d1a.. temazepam [hypnotic] res55: anxiolytic_hypnotic drug Read
d1b.. triazolam res55: anxiolytic_hypnotic drug Read
d1c.. triclofos sodium res55: anxiolytic_hypnotic drug Read
d1d.. zoplicone res55: anxiolytic_hypnotic drug Read
d1f.. zolpidem res55: anxiolytic_hypnotic drug Read
d1g.. zaleplon res55: anxiolytic_hypnotic drug Read
d2... anxiolytics res55: anxiolytic_hypnotic drug Read
d21.. diazepam [anxiolytic] res55: anxiolytic_hypnotic drug Read
d22.. alprazolam res55: anxiolytic_hypnotic drug Read
d23.. bromazepam res55: anxiolytic_hypnotic drug Read
d24.. chlordiazepoxide res55: anxiolytic_hypnotic drug Read
d25.. chlormezanone res55: anxiolytic_hypnotic drug Read
d26.. clobazam res55: anxiolytic_hypnotic drug Read
d29.. *ketazolam res55: anxiolytic_hypnotic drug Read
d2a.. lorazepam [anxiolytic] res55: anxiolytic_hypnotic drug Read
d2b.. *medazepam res55: anxiolytic_hypnotic drug Read
d2c.. meprobamate res55: anxiolytic_hypnotic drug Read
d2d.. oxazepam res55: anxiolytic_hypnotic drug Read
d2e.. *prazepam res55: anxiolytic_hypnotic drug Read
d2f.. buspirone hydrochloride res55: anxiolytic_hypnotic drug Read
d3.. barbiturates/methyprylone res55: anxiolytic_hypnotic drug Read
d31.. barbiturates res55: anxiolytic_hypnotic drug Read
d32.. methyprylone res55: anxiolytic_hypnotic drug Read
dC1.. sodium oxybate res55: anxiolytic_hypnotic drug Read
dn4.. clonazepam [epilepsy control] res55: anxiolytic_hypnotic drug Read
dn6.. methylphenobarbital res55: anxiolytic_hypnotic drug Read
dn7.. phenobarbital res55: anxiolytic_hypnotic drug Read
dnc.. clobazam [epilepsy only] res55: anxiolytic_hypnotic drug Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH466/version/932/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH466/version/932/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH466', '932', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH466/version/932/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH466/version/932/export/codes/?format=json
CSV site_root/phenotypes/PH466/version/932/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH466', '932', api_client=client)

Version History

Version
ID
Name Owner Publish date
932 Anxiolytic Hypnotic ieuan.scanlon 2021-10-06 currently shown

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