Print

Cancer

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

Type
Disease or Syndrome
ID
PH873
Version ID
1825
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: 1529
Code Description Entity type Coding System (ICD-10 Read) Category
1409A res69: cancer Read diagnostic
1409C res69: cancer Read diagnostic
1419A res69: cancer Read diagnostic
1419AA res69: cancer Read diagnostic
1419C res69: cancer Read diagnostic
1420A res69: cancer Read diagnostic
1429B res69: cancer Read diagnostic
1429C res69: cancer Read diagnostic
1439A res69: cancer Read diagnostic
144 C res69: cancer Read diagnostic
1450C res69: cancer Read diagnostic
1459A res69: cancer Read diagnostic
1459C res69: cancer Read diagnostic
1460A res69: cancer Read diagnostic
1460C res69: cancer Read diagnostic
147 A res69: cancer Read diagnostic
1480C res69: cancer Read diagnostic
149 A res69: cancer Read diagnostic
149 AT res69: cancer Read diagnostic
149 C res69: cancer Read diagnostic
149 CT res69: cancer Read diagnostic
150 A res69: cancer Read diagnostic
150 C res69: cancer Read diagnostic
1519A res69: cancer Read diagnostic
1519AA res69: cancer Read diagnostic
1519B res69: cancer Read diagnostic
1519BL res69: cancer Read diagnostic
1519C res69: cancer Read diagnostic
1519CL res69: cancer Read diagnostic
1519DA res69: cancer Read diagnostic
1519L res69: cancer Read diagnostic
1520A res69: cancer Read diagnostic
1520B res69: cancer Read diagnostic
1529A res69: cancer Read diagnostic
1529B res69: cancer Read diagnostic
1529BL res69: cancer Read diagnostic
1529C res69: cancer Read diagnostic
1530AC res69: cancer Read diagnostic
1530AD res69: cancer Read diagnostic
1530CC res69: cancer Read diagnostic
1533A res69: cancer Read diagnostic
1533AD res69: cancer Read diagnostic
1538A res69: cancer Read diagnostic
1538AD res69: cancer Read diagnostic
1538AN res69: cancer Read diagnostic
1538B res69: cancer Read diagnostic
1538C res69: cancer Read diagnostic
1538CN res69: cancer Read diagnostic
1539A res69: cancer Read diagnostic
1539AT res69: cancer Read diagnostic
1539C res69: cancer Read diagnostic
1541A res69: cancer Read diagnostic
1541C res69: cancer Read diagnostic
1542C res69: cancer Read diagnostic
1550A res69: cancer Read diagnostic
1550AP res69: cancer Read diagnostic
1550B res69: cancer Read diagnostic
1550BH res69: cancer Read diagnostic
1550BP res69: cancer Read diagnostic
1550C res69: cancer Read diagnostic
1550HB res69: cancer Read diagnostic
1550HC res69: cancer Read diagnostic
1551C res69: cancer Read diagnostic
1560A res69: cancer Read diagnostic
1560C res69: cancer Read diagnostic
1561C res69: cancer Read diagnostic
1562C res69: cancer Read diagnostic
1569A res69: cancer Read diagnostic
1579A res69: cancer Read diagnostic
1579C res69: cancer Read diagnostic
1579CL res69: cancer Read diagnostic
1589MP res69: cancer Read diagnostic
159 res69: cancer Read diagnostic
159 A res69: cancer Read diagnostic
159 C res69: cancer Read diagnostic
159 CD res69: cancer Read diagnostic
1600A res69: cancer Read diagnostic
1601A res69: cancer Read diagnostic
1601AC res69: cancer Read diagnostic
1608A res69: cancer Read diagnostic
1608CM res69: cancer Read diagnostic
1609A res69: cancer Read diagnostic
1610A res69: cancer Read diagnostic
1618A res69: cancer Read diagnostic
1619A res69: cancer Read diagnostic
1619C res69: cancer Read diagnostic
1619CV res69: cancer Read diagnostic
1620A res69: cancer Read diagnostic
1620C res69: cancer Read diagnostic
1621A res69: cancer Read diagnostic
1621AB res69: cancer Read diagnostic
1621C res69: cancer Read diagnostic
1621CB res69: cancer Read diagnostic
1621D res69: cancer Read diagnostic
1630A res69: cancer Read diagnostic
1631A res69: cancer Read diagnostic
1639MA res69: cancer Read diagnostic
1700AM res69: cancer Read diagnostic
1701A res69: cancer Read diagnostic
1702P res69: cancer Read diagnostic
1703A res69: cancer Read diagnostic
1709A res69: cancer Read diagnostic
1709AK res69: cancer Read diagnostic
1709B res69: cancer Read diagnostic
1709C res69: cancer Read diagnostic
1709D res69: cancer Read diagnostic
1719AC res69: cancer Read diagnostic
1719B res69: cancer Read diagnostic
1719F res69: cancer Read diagnostic
1719FB res69: cancer Read diagnostic
1719H res69: cancer Read diagnostic
1719LM res69: cancer Read diagnostic
1719M res69: cancer Read diagnostic
1719RB res69: cancer Read diagnostic
1719RH res69: cancer Read diagnostic
1723A res69: cancer Read diagnostic
1723C res69: cancer Read diagnostic
1729 res69: cancer Read diagnostic
1729B res69: cancer Read diagnostic
1729L res69: cancer Read diagnostic
1731AL res69: cancer Read diagnostic
1732AC res69: cancer Read diagnostic
1733AC res69: cancer Read diagnostic
1733AF res69: cancer Read diagnostic
1734AC res69: cancer Read diagnostic
1735C res69: cancer Read diagnostic
1735CP res69: cancer Read diagnostic
1736AN res69: cancer Read diagnostic
1736CN res69: cancer Read diagnostic
1739A res69: cancer Read diagnostic
1739B res69: cancer Read diagnostic
1739BP res69: cancer Read diagnostic
1739C res69: cancer Read diagnostic
1739CM res69: cancer Read diagnostic
1739CS res69: cancer Read diagnostic
174 A res69: cancer Read diagnostic
174 AN res69: cancer Read diagnostic
174 C res69: cancer Read diagnostic
174 CI res69: cancer Read diagnostic
174 DC res69: cancer Read diagnostic
174 DL res69: cancer Read diagnostic
174 PB res69: cancer Read diagnostic
174 PN res69: cancer Read diagnostic
180 A res69: cancer Read diagnostic
180 C res69: cancer Read diagnostic
181 C res69: cancer Read diagnostic
1820A res69: cancer Read diagnostic
1820C res69: cancer Read diagnostic
1829A res69: cancer Read diagnostic
1829C res69: cancer Read diagnostic
1830A res69: cancer Read diagnostic
1830AD res69: cancer Read diagnostic
1830AU res69: cancer Read diagnostic
1830C res69: cancer Read diagnostic
1830MC res69: cancer Read diagnostic
1830T res69: cancer Read diagnostic
1830TT res69: cancer Read diagnostic
1840A res69: cancer Read diagnostic
1841A res69: cancer Read diagnostic
1841C res69: cancer Read diagnostic
1849A res69: cancer Read diagnostic
185 A res69: cancer Read diagnostic
185 C res69: cancer Read diagnostic
185 CA res69: cancer Read diagnostic
186 A res69: cancer Read diagnostic
186 AN res69: cancer Read diagnostic
186 B res69: cancer Read diagnostic
186 BL res69: cancer Read diagnostic
186 C res69: cancer Read diagnostic
186 CH res69: cancer Read diagnostic
186 EM res69: cancer Read diagnostic
186 NT res69: cancer Read diagnostic
186 RC res69: cancer Read diagnostic
186 T res69: cancer Read diagnostic
186 TA res69: cancer Read diagnostic
186 TM res69: cancer Read diagnostic
1870A res69: cancer Read diagnostic
1878 res69: cancer Read diagnostic
1879A res69: cancer Read diagnostic
188 A res69: cancer Read diagnostic
188 C res69: cancer Read diagnostic
188 CT res69: cancer Read diagnostic
188 RC res69: cancer Read diagnostic
188 RH res69: cancer Read diagnostic
188 TC res69: cancer Read diagnostic
1890A res69: cancer Read diagnostic
1890AD res69: cancer Read diagnostic
1890BL res69: cancer Read diagnostic
1890C res69: cancer Read diagnostic
1890CH res69: cancer Read diagnostic
1890HM res69: cancer Read diagnostic
1890MB res69: cancer Read diagnostic
1890NR res69: cancer Read diagnostic
1890R res69: cancer Read diagnostic
1890W res69: cancer Read diagnostic
1891C res69: cancer Read diagnostic
1892A res69: cancer Read diagnostic
1892C res69: cancer Read diagnostic
1899A res69: cancer Read diagnostic
1899C res69: cancer Read diagnostic
1899T res69: cancer Read diagnostic
190 A res69: cancer Read diagnostic
190 B res69: cancer Read diagnostic
191 A res69: cancer Read diagnostic
191 BC res69: cancer Read diagnostic
191 MB res69: cancer Read diagnostic
1922A res69: cancer Read diagnostic
1923 res69: cancer Read diagnostic
1924NF res69: cancer Read diagnostic
1925GN res69: cancer Read diagnostic
1925NB res69: cancer Read diagnostic
1929A res69: cancer Read diagnostic
1929AC res69: cancer Read diagnostic
1929D res69: cancer Read diagnostic
1929DG res69: cancer Read diagnostic
1929EP res69: cancer Read diagnostic
1929GL res69: cancer Read diagnostic
1929MN res69: cancer Read diagnostic
193 A res69: cancer Read diagnostic
193 AG res69: cancer Read diagnostic
193 C res69: cancer Read diagnostic
1942AM res69: cancer Read diagnostic
1943A res69: cancer Read diagnostic
1950 res69: cancer Read diagnostic
1950A res69: cancer Read diagnostic
1950MA res69: cancer Read diagnostic
1959AA res69: cancer Read diagnostic
1959AE res69: cancer Read diagnostic
1959AG res69: cancer Read diagnostic
1959BA res69: cancer Read diagnostic
1959BB res69: cancer Read diagnostic
1959BD res69: cancer Read diagnostic
1959CA res69: cancer Read diagnostic
1959CB res69: cancer Read diagnostic
1959CF res69: cancer Read diagnostic
1959DA res69: cancer Read diagnostic
1959DB res69: cancer Read diagnostic
1991A res69: cancer Read diagnostic
1991AD res69: cancer Read diagnostic
1991C res69: cancer Read diagnostic
1991CR res69: cancer Read diagnostic
1991M res69: cancer Read diagnostic
1991MC res69: cancer Read diagnostic
1991MR res69: cancer Read diagnostic
1991MT res69: cancer Read diagnostic
1991NC res69: cancer Read diagnostic
1992L res69: cancer Read diagnostic
2000 res69: cancer Read diagnostic
2001 res69: cancer Read diagnostic
2001BL res69: cancer Read diagnostic
201 res69: cancer Read diagnostic
201 G res69: cancer Read diagnostic
2020 res69: cancer Read diagnostic
2020BR res69: cancer Read diagnostic
2020FB res69: cancer Read diagnostic
2020FL res69: cancer Read diagnostic
2020FR res69: cancer Read diagnostic
2021 res69: cancer Read diagnostic
2022 res69: cancer Read diagnostic
2022BK res69: cancer Read diagnostic
2022CL res69: cancer Read diagnostic
2022GR res69: cancer Read diagnostic
2022LK res69: cancer Read diagnostic
2022ML res69: cancer Read diagnostic
2029AL res69: cancer Read diagnostic
2029CH res69: cancer Read diagnostic
2029LD res69: cancer Read diagnostic
203 res69: cancer Read diagnostic
203 A res69: cancer Read diagnostic
203 FR res69: cancer Read diagnostic
203 HC res69: cancer Read diagnostic
203 KA res69: cancer Read diagnostic
203 N res69: cancer Read diagnostic
203 PL res69: cancer Read diagnostic
203 T res69: cancer Read diagnostic
2040 res69: cancer Read diagnostic
2041 res69: cancer Read diagnostic
2049 res69: cancer Read diagnostic
2049AD res69: cancer Read diagnostic
2050 res69: cancer Read diagnostic
2050MB res69: cancer Read diagnostic
2050MM res69: cancer Read diagnostic
2050PM res69: cancer Read diagnostic
2050RA res69: cancer Read diagnostic
2051 res69: cancer Read diagnostic
2051GR res69: cancer Read diagnostic
2051MC res69: cancer Read diagnostic
2059E res69: cancer Read diagnostic
2059M res69: cancer Read diagnostic
2059MB res69: cancer Read diagnostic
2059MC res69: cancer Read diagnostic
2059MP res69: cancer Read diagnostic
2059MR res69: cancer Read diagnostic
2060 res69: cancer Read diagnostic
2061 res69: cancer Read diagnostic
2062 res69: cancer Read diagnostic
2069 res69: cancer Read diagnostic
2070 res69: cancer Read diagnostic
2070BL res69: cancer Read diagnostic
2070MA res69: cancer Read diagnostic
2070MC res69: cancer Read diagnostic
2070MG res69: cancer Read diagnostic
2071 res69: cancer Read diagnostic
2072AE res69: cancer Read diagnostic
2072DG res69: cancer Read diagnostic
2072EL res69: cancer Read diagnostic
2079 res69: cancer Read diagnostic
2079AL res69: cancer Read diagnostic
2079MK res69: cancer Read diagnostic
2079PC res69: cancer Read diagnostic
208 res69: cancer Read diagnostic
208 BL res69: cancer Read diagnostic
208 CE res69: cancer Read diagnostic
208 RV res69: cancer Read diagnostic
209 res69: cancer Read diagnostic
209 CL res69: cancer Read diagnostic
209 HM res69: cancer Read diagnostic
2102A res69: cancer Read diagnostic
2102AP res69: cancer Read diagnostic
2102MP res69: cancer Read diagnostic
2104AD res69: cancer Read diagnostic
2104DN res69: cancer Read diagnostic
2104EP res69: cancer Read diagnostic
B....00 Neoplasms res69: cancer Read diagnostic
B....11 Cancers res69: cancer Read diagnostic
B0...00 Malignant neoplasm of lip, oral cavity and pharynx res69: cancer Read diagnostic
B0...11 Carcinoma of lip, oral cavity and pharynx res69: cancer Read diagnostic
B00..00 Malignant neoplasm of lip res69: cancer Read diagnostic
B00..11 Carcinoma of lip res69: cancer Read diagnostic
B000.00 Malignant neoplasm of upper lip, vermilion border res69: cancer Read diagnostic
B000000 Malignant neoplasm of upper lip, external res69: cancer Read diagnostic
B000100 Malignant neoplasm of upper lip, lipstick area res69: cancer Read diagnostic
B000z00 Malignant neoplasm of upper lip, vermilion border NOS res69: cancer Read diagnostic
B001.00 Malignant neoplasm of lower lip, vermilion border res69: cancer Read diagnostic
B001000 Malignant neoplasm of lower lip, external res69: cancer Read diagnostic
B001100 Malignant neoplasm of lower lip, lipstick area res69: cancer Read diagnostic
B001z00 Malignant neoplasm of lower lip, vermilion border NOS res69: cancer Read diagnostic
B002.00 Malignant neoplasm of upper lip, inner aspect res69: cancer Read diagnostic
B002100 Malignant neoplasm of upper lip, frenulum res69: cancer Read diagnostic
B002200 Malignant neoplasm of upper lip, mucosa res69: cancer Read diagnostic
B002300 Malignant neoplasm of upper lip, oral aspect res69: cancer Read diagnostic
B002z00 Malignant neoplasm of upper lip, inner aspect NOS res69: cancer Read diagnostic
B003.00 Malignant neoplasm of lower lip, inner aspect res69: cancer Read diagnostic
B003000 Malignant neoplasm of lower lip, buccal aspect res69: cancer Read diagnostic
B003100 Malignant neoplasm of lower lip, frenulum res69: cancer Read diagnostic