Print

Abdominal Pain

Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland

Type
Disease or Syndrome
ID
PH863
Version ID
1805
Data Sources
Valid event data range
01/01/2005 - 30/11/2018
Sex
Female, Male
Agreement Date
2022-02-02
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Studies 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.

Methods:

This 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.

Results:

The 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.

Conclusions:

Mortality 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.

Publications

  • 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.

Clinical Code List

Rows: 76
Code Description Entity type Category Coding System (Read)
14CF.00 history of irritable bowel syndrome res176: Abdominal pain diagnostic Read
196..00 type of git pain res176: Abdominal pain diagnostic Read
196..11 abdominal pain type res176: Abdominal pain diagnostic Read
196..12 type of git pain - symptom res176: Abdominal pain diagnostic Read
1962 colicky abdominal pain res176: Abdominal pain diagnostic Read
1963 non-colicky abdominal pain res176: Abdominal pain diagnostic Read
1964 shoulder pain from abdomen res176: Abdominal pain diagnostic Read
1969 abdominal pain res176: Abdominal pain diagnostic Read
1969000 abdominal wall pain res176: Abdominal pain diagnostic Read
196A.00 hunger pain res176: Abdominal pain diagnostic Read
196Z.00 type of git pain nos res176: Abdominal pain diagnostic Read
197..00 site of git pain res176: Abdominal pain diagnostic Read
197..11 flank pain res176: Abdominal pain diagnostic Read
197..12 iliac fossa pain res176: Abdominal pain diagnostic Read
197..13 site of abdominal pain res176: Abdominal pain diagnostic Read
197..14 subcostal pain res176: Abdominal pain diagnostic Read
1971 central abdominal pain res176: Abdominal pain diagnostic Read
1972 epigastric pain res176: Abdominal pain diagnostic Read
1973 left subcostal pain res176: Abdominal pain diagnostic Read
1974 right subcostal pain res176: Abdominal pain diagnostic Read
1975 left flank pain res176: Abdominal pain diagnostic Read
1976 right flank pain res176: Abdominal pain diagnostic Read
1977 right iliac fossa pain res176: Abdominal pain diagnostic Read
1978 left iliac fossa pain res176: Abdominal pain diagnostic Read
1979 suprapubic pain res176: Abdominal pain diagnostic Read
197A.00 generalised abdominal pain res176: Abdominal pain diagnostic Read
197A.11 general abdominal pain-symptom res176: Abdominal pain diagnostic Read
197B.00 upper abdominal pain res176: Abdominal pain diagnostic Read
197C.00 lower abdominal pain res176: Abdominal pain diagnostic Read
197D.00 right upper quadrant pain res176: Abdominal pain diagnostic Read
197Z.00 site of git pain nos res176: Abdominal pain diagnostic Read
25C..00 o/e - abdo. pain on palpation res176: Abdominal pain diagnostic Read
25C..11 o/e - epigastric pain on palp. res176: Abdominal pain diagnostic Read
25C..12 o/e - iliac pain on palpation res176: Abdominal pain diagnostic Read
25C..13 o/e - lumbar pain on palpation res176: Abdominal pain diagnostic Read
25C..14 o/e - umbilical pain on palp. res176: Abdominal pain diagnostic Read
25C2.00 o/e - abd.pain-r.hypochondrium res176: Abdominal pain diagnostic Read
25C3.00 o/e - abd. pain - epigastrium res176: Abdominal pain diagnostic Read
25C4.00 o/e - abd.pain-l.hypochondrium res176: Abdominal pain diagnostic Read
25C5.00 o/e - abd. pain - r.lumbar res176: Abdominal pain diagnostic Read
25C6.00 o/e - abd. pain - umbilical res176: Abdominal pain diagnostic Read
25C7.00 o/e - abd. pain - l.lumbar res176: Abdominal pain diagnostic Read
25C8.00 o/e - abd. pain - r.iliac res176: Abdominal pain diagnostic Read
25C9.00 o/e - abd. pain - hypogastrium res176: Abdominal pain diagnostic Read
25CA.00 o/e - abd. pain - l.iliac res176: Abdominal pain diagnostic Read
25CZ.00 o/e -abd.pain on palpation nos res176: Abdominal pain diagnostic Read
J521.00 irritable colon - irritable bowel syndrome res176: Abdominal pain diagnostic Read
J521.11 irritable bowel syndrome res176: Abdominal pain diagnostic Read
J521.13 spastic colon res176: Abdominal pain diagnostic Read
J521000 irritable bowel syndrome with diarrhoea res176: Abdominal pain diagnostic Read
J521100 irritable bowel syndrome characterised by constipation res176: Abdominal pain diagnostic Read
R073200 [d]gas pain (abdominal) res176: Abdominal pain diagnostic Read
R090.00 [d]abdominal pain res176: Abdominal pain diagnostic Read
R090500 [d]epigastric pain res176: Abdominal pain diagnostic Read
R090600 [d]umbilical pain res176: Abdominal pain diagnostic Read
R090700 [d]hypochondrial pain res176: Abdominal pain diagnostic Read
R090800 [d]suprapubic pain res176: Abdominal pain diagnostic Read
R090900 [d]pain in right iliac fossa res176: Abdominal pain diagnostic Read
R090A00 [d]pain in left iliac fossa res176: Abdominal pain diagnostic Read
R090B00 [d]groin pain res176: Abdominal pain diagnostic Read
R090C00 [d]loin pain res176: Abdominal pain diagnostic Read
R090E00 [d]recurrent acute abdominal pain res176: Abdominal pain diagnostic Read
R090G00 [d]pelvic and perineal pain res176: Abdominal pain diagnostic Read
R090G11 [d] pelvic pain res176: Abdominal pain diagnostic Read
R090G12 [d] perineal pain res176: Abdominal pain diagnostic Read
R090H00 [d]upper abdominal pain res176: Abdominal pain diagnostic Read
R090J00 [d]right upper quadrant pain res176: Abdominal pain diagnostic Read
R090K00 [d]left upper quadrant pain res176: Abdominal pain diagnostic Read
R090L00 [d]left lower quadrant pain res176: Abdominal pain diagnostic Read
R090M00 [d]right lower quadrant pain res176: Abdominal pain diagnostic Read
R090N00 [d]nonspecific abdominal pain res176: Abdominal pain diagnostic Read
R090P00 [d]functional abdominal pain syndrome res176: Abdominal pain diagnostic Read
R090y00 [d]other specified abdominal pain res176: Abdominal pain diagnostic Read
R090z00 [d]abdominal pain nos res176: Abdominal pain diagnostic Read
Ryu1000 [x]pain localized to other parts of lower abdomen res176: Abdominal pain diagnostic Read
Ryu1100 [x]other and unspecified abdominal pain res176: Abdominal pain diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH863/version/1805/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH863/version/1805/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('PH863', '1805', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH863/version/1805/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH863/version/1805/export/codes/?format=json
CSV site_root/phenotypes/PH863/version/1805/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('PH863', '1805', api_client=client)

Version History

Version
ID
Name Owner Publish date
1805 Abdominal Pain ieuan.scanlon 2022-04-04 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

Print - Print page.