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AIDS

Catherine Morgan, Roger T Webb, Mathew J Carr, Evangelos Kontopantelis, Carolyn A Chew-Graham, Nav Kapur, Darren M. Ashcroft

Type
Disease or Syndrome
ID
PH870
Version ID
1819
Data Sources
Valid event data range
01/01/2001 - 31/12/2014
Sex
Female, Male
Agreement Date
2018-10-15
Coding system
Read codes v2 ICD10 codes
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Self-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.

Methods:

The 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.

Findings:

Overall 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.

Interpretation:

Within 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.

Publications

  • 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.

Clinical Code List

Rows: 34
Code Description Entity type Coding System (ICD-10 Read) Category
799MD res69: aids Read diagnostic
A788.00 Acquired immune deficiency syndrome res69: aids Read diagnostic
A788100 Asymptomatic human immunodeficiency virus infection res69: aids Read diagnostic
A788200 HIV infection with persistent generalised lymphadenopathy res69: aids Read diagnostic
A788300 Human immunodeficiency virus with constitutional disease res69: aids Read diagnostic
A788400 Human immunodeficiency virus with neurological disease res69: aids Read diagnostic
A788500 Human immunodeficiency virus with secondary infection res69: aids Read diagnostic
A788600 Human immunodeficiency virus with secondary cancers res69: aids Read diagnostic
A788U00 HIV disease result/haematological+immunologic abnorms,NEC res69: aids Read diagnostic
A788W00 HIV disease resulting in unspecified malignant neoplasm res69: aids Read diagnostic
A788X00 HIV disease resulting/unspcf infectious+parasitic disease res69: aids Read diagnostic
A788y00 Human immunodeficiency virus with other clinical findings res69: aids Read diagnostic
A788z00 Acquired human immunodeficiency virus infection syndrome NOS res69: aids Read diagnostic
A789.00 Human immunodef virus resulting in other disease res69: aids Read diagnostic
A789000 HIV disease resulting in mycobacterial infection res69: aids Read diagnostic
A789100 HIV disease resulting in cytomegaloviral disease res69: aids Read diagnostic
A789200 HIV disease resulting in candidiasis res69: aids Read diagnostic
A789300 HIV disease resulting in Pneumocystis carinii pneumonia res69: aids Read diagnostic
A789400 HIV disease resulting in multiple infections res69: aids Read diagnostic
A789500 HIV disease resulting in Kaposi's sarcoma res69: aids Read diagnostic
A789600 HIV disease resulting in Burkitt's lymphoma res69: aids Read diagnostic
A789800 HIV disease resulting in multiple malignant neoplasms res69: aids Read diagnostic
A789900 HIV disease resulting in lymphoid interstitial pneumonitis res69: aids Read diagnostic
A789A00 HIV disease resulting in wasting syndrome res69: aids Read diagnostic
A789X00 HIV dis reslt/oth mal neopl/lymph,h'matopoetc+reltd tissu res69: aids Read diagnostic
AyuC.00 [X]Human immunodeficiency virus disease res69: aids Read diagnostic
AyuC100 [X]HIV disease resulting in other viral infections res69: aids Read diagnostic
AyuC300 [X]HIV disease resulting in multiple infections res69: aids Read diagnostic
AyuC400 [X]HIV disease resulting/other infectious+parasitic diseases res69: aids Read diagnostic
AyuC600 [X]HIV disease resulting in other non-Hodgkin's lymphoma res69: aids Read diagnostic
AyuCB00 [X]HIV disease result/haematological+immunologic abnorms,NEC res69: aids Read diagnostic
AyuCC00 [X]HIV disease resulting in other specified conditions res69: aids Read diagnostic
AyuCD00 [X]Unspecified human immunodeficiency virus [HIV] disease res69: aids Read diagnostic
L7990A res69: aids Read diagnostic
Rows: 1
Code Description Entity type Coding System (ICD-10 Read) Category
B20-B24 Human immunodeficiency virus (HIV) disease res69: aids ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH870/version/1819/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH870/version/1819/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('PH870', '1819', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH870/version/1819/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH870/version/1819/export/codes/?format=json
CSV site_root/phenotypes/PH870/version/1819/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('PH870', '1819', api_client=client)

Version History

Version
ID
Name Owner Publish date
1819 AIDS ieuan.scanlon 2022-04-04 currently shown

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

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