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Cerebrovascular Disease

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

Type
Disease or Syndrome
ID
PH874
Version ID
1827
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: 78
Code Description Entity type Coding System (ICD-10 Read) Category
1477.00 H/O: cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
14A7.00 H/O: CVA/stroke res69: cerebrovascular_disease Read diagnostic
14A7.12 H/O: stroke res69: cerebrovascular_disease Read diagnostic
662M.00 Stroke monitoring res69: cerebrovascular_disease Read diagnostic
7004300 Evacuation of intracerebral haematoma NEC res69: cerebrovascular_disease Read diagnostic
F11x200 Cerebral degeneration due to cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
G6...00 Cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
G60..00 Subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
G600.00 Ruptured berry aneurysm res69: cerebrovascular_disease Read diagnostic
G601.00 Subarachnoid haemorrhage from carotid siphon and bifurcation res69: cerebrovascular_disease Read diagnostic
G602.00 Subarachnoid haemorrhage from middle cerebral artery res69: cerebrovascular_disease Read diagnostic
G603.00 Subarachnoid haemorrhage from anterior communicating artery res69: cerebrovascular_disease Read diagnostic
G604.00 Subarachnoid haemorrhage from posterior communicating artery res69: cerebrovascular_disease Read diagnostic
G605.00 Subarachnoid haemorrhage from basilar artery res69: cerebrovascular_disease Read diagnostic
G606.00 Subarachnoid haemorrhage from vertebral artery res69: cerebrovascular_disease Read diagnostic
G60X.00 Subarachnoid haemorrh from intracranial artery, unspecif res69: cerebrovascular_disease Read diagnostic
G60z.00 Subarachnoid haemorrhage NOS res69: cerebrovascular_disease Read diagnostic
G61..00 Intracerebral haemorrhage res69: cerebrovascular_disease Read diagnostic
G61..11 CVA - cerebrovascular accid due to intracerebral haemorrhage res69: cerebrovascular_disease Read diagnostic
G61..12 Stroke due to intracerebral haemorrhage res69: cerebrovascular_disease Read diagnostic
G613.00 Cerebellar haemorrhage res69: cerebrovascular_disease Read diagnostic
G617.00 Intracerebral haemorrhage, intraventricular res69: cerebrovascular_disease Read diagnostic
G618.00 Intracerebral haemorrhage, multiple localized res69: cerebrovascular_disease Read diagnostic
G61X.00 Intracerebral haemorrhage in hemisphere, unspecified res69: cerebrovascular_disease Read diagnostic
G61X000 Left sided intracerebral haemorrhage, unspecified res69: cerebrovascular_disease Read diagnostic
G61X100 Right sided intracerebral haemorrhage, unspecified res69: cerebrovascular_disease Read diagnostic
G61z.00 Intracerebral haemorrhage NOS res69: cerebrovascular_disease Read diagnostic
G623.00 Subdural haemorrhage NOS res69: cerebrovascular_disease Read diagnostic
G62z.00 Intracranial haemorrhage NOS res69: cerebrovascular_disease Read diagnostic
G63..00 Precerebral arterial occlusion res69: cerebrovascular_disease Read diagnostic
G63..12 Stenosis of precerebral arteries res69: cerebrovascular_disease Read diagnostic
G633.00 Multiple and bilateral precerebral arterial occlusion res69: cerebrovascular_disease Read diagnostic
G63y.00 Other precerebral artery occlusion res69: cerebrovascular_disease Read diagnostic
G63z.00 Precerebral artery occlusion NOS res69: cerebrovascular_disease Read diagnostic
G64..13 Stroke due to cerebral arterial occlusion res69: cerebrovascular_disease Read diagnostic
G641000 Cerebral infarction due to embolism of cerebral arteries res69: cerebrovascular_disease Read diagnostic
G65..00 Transient cerebral ischaemia res69: cerebrovascular_disease Read diagnostic
G65y.00 Other transient cerebral ischaemia res69: cerebrovascular_disease Read diagnostic
G65z.00 Transient cerebral ischaemia NOS res69: cerebrovascular_disease Read diagnostic
G65zz00 Transient cerebral ischaemia NOS res69: cerebrovascular_disease Read diagnostic
G66..00 Stroke and cerebrovascular accident unspecified res69: cerebrovascular_disease Read diagnostic
G66..11 CVA unspecified res69: cerebrovascular_disease Read diagnostic
G66..12 Stroke unspecified res69: cerebrovascular_disease Read diagnostic
G66..13 CVA - Cerebrovascular accident unspecified res69: cerebrovascular_disease Read diagnostic
G660.00 Middle cerebral artery syndrome res69: cerebrovascular_disease Read diagnostic
G661.00 Anterior cerebral artery syndrome res69: cerebrovascular_disease Read diagnostic
G662.00 Posterior cerebral artery syndrome res69: cerebrovascular_disease Read diagnostic
G663.00 Brain stem stroke syndrome res69: cerebrovascular_disease Read diagnostic
G664.00 Cerebellar stroke syndrome res69: cerebrovascular_disease Read diagnostic
G665.00 Pure motor lacunar syndrome res69: cerebrovascular_disease Read diagnostic
G666.00 Pure sensory lacunar syndrome res69: cerebrovascular_disease Read diagnostic
G667.00 Left sided CVA res69: cerebrovascular_disease Read diagnostic
G668.00 Right sided CVA res69: cerebrovascular_disease Read diagnostic
G669.00 Cerebral palsy, not congenital or infantile, acute res69: cerebrovascular_disease Read diagnostic
G67..00 Other cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
G671.00 Generalised ischaemic cerebrovascular disease NOS res69: cerebrovascular_disease Read diagnostic
G671z00 Generalised ischaemic cerebrovascular disease NOS res69: cerebrovascular_disease Read diagnostic
G677400 Occlusion+stenosis of multiple and bilat cerebral arteries res69: cerebrovascular_disease Read diagnostic
G67y.00 Other cerebrovascular disease OS res69: cerebrovascular_disease Read diagnostic
G67z.00 Other cerebrovascular disease NOS res69: cerebrovascular_disease Read diagnostic
G68..00 Late effects of cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
G680.00 Sequelae of subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
G681.00 Sequelae of intracerebral haemorrhage res69: cerebrovascular_disease Read diagnostic
G68W.00 Sequelae/other + unspecified cerebrovascular diseases res69: cerebrovascular_disease Read diagnostic
G6y..00 Other specified cerebrovascular disease res69: cerebrovascular_disease Read diagnostic
G6z..00 Cerebrovascular disease NOS res69: cerebrovascular_disease Read diagnostic
Gyu6.00 [X]Cerebrovascular diseases res69: cerebrovascular_disease Read diagnostic
Gyu6000 [X]Subarachnoid haemorrhage from other intracranial arteries res69: cerebrovascular_disease Read diagnostic
Gyu6100 [X]Other subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
Gyu6200 [X]Other intracerebral haemorrhage res69: cerebrovascular_disease Read diagnostic
Gyu6500 [X]Occlusion and stenosis of other precerebral arteries res69: cerebrovascular_disease Read diagnostic
Gyu6600 [X]Occlusion and stenosis of other cerebral arteries res69: cerebrovascular_disease Read diagnostic
Gyu6F00 [X]Intracerebral haemorrhage in hemisphere, unspecified res69: cerebrovascular_disease Read diagnostic
S62..12 Subarachnoid haemorrhage following injury res69: cerebrovascular_disease Read diagnostic
S620.00 Closed traumatic subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
S621.00 Open traumatic subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
S627.00 Traumatic subarachnoid haemorrhage res69: cerebrovascular_disease Read diagnostic
S628.00 Traumatic subdural haemorrhage res69: cerebrovascular_disease Read diagnostic
Rows: 3
Code Description Entity type Coding System (ICD-10 Read) Category
G45 Transient cerebral ischaemic attacks and related syndromes res69: cerebrovascular_disease ICD-10 diagnostic
G46 Vascular syndromes of brain in cerebrovascular diseases res69: cerebrovascular_disease ICD-10 diagnostic
I60-I69 Cerebrovascular diseases res69: cerebrovascular_disease ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH874/version/1827/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH874/version/1827/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('PH874', '1827', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH874/version/1827/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH874/version/1827/export/codes/?format=json
CSV site_root/phenotypes/PH874/version/1827/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('PH874', '1827', api_client=client)

Version History

Version
ID
Name Owner Publish date
1827 Cerebrovascular Disease ieuan.scanlon 2022-04-04 currently shown

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