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Mild Liver Disease

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

ID
PH884
Version ID
1847
Type
Disease or Syndrome
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
Collections
ClinicalCodes Repository Phenotype Library
Tags
No tags

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: 35
Code Description Entity type Coding System (ICD-10 Read) Category
C310400 Glycogenosis with hepatic cirrhosis res69: mild_liver_disease Read diagnostic
C350012 Pigmentary cirrhosis of liver res69: mild_liver_disease Read diagnostic
J600200 Acute yellow atrophy res69: mild_liver_disease Read diagnostic
J601200 Subacute yellow atrophy res69: mild_liver_disease Read diagnostic
J61..00 Cirrhosis and chronic liver disease res69: mild_liver_disease Read diagnostic
J612.00 Alcoholic cirrhosis of liver res69: mild_liver_disease Read diagnostic
J612.11 Florid cirrhosis res69: mild_liver_disease Read diagnostic
J614.00 Chronic hepatitis res69: mild_liver_disease Read diagnostic
J614000 Chronic persistent hepatitis res69: mild_liver_disease Read diagnostic
J614100 Chronic active hepatitis res69: mild_liver_disease Read diagnostic
J614200 Chronic aggressive hepatitis res69: mild_liver_disease Read diagnostic
J614300 Recurrent hepatitis res69: mild_liver_disease Read diagnostic
J614y00 Chronic hepatitis unspecified res69: mild_liver_disease Read diagnostic
J614z00 Chronic hepatitis NOS res69: mild_liver_disease Read diagnostic
J615.00 Cirrhosis - non alcoholic res69: mild_liver_disease Read diagnostic
J615.11 Portal cirrhosis res69: mild_liver_disease Read diagnostic
J615100 Multilobular portal cirrhosis res69: mild_liver_disease Read diagnostic
J615300 Diffuse nodular cirrhosis res69: mild_liver_disease Read diagnostic
J615400 Fatty portal cirrhosis res69: mild_liver_disease Read diagnostic
J615700 Cardiac portal cirrhosis res69: mild_liver_disease Read diagnostic
J615C00 Xanthomatous portal cirrhosis res69: mild_liver_disease Read diagnostic
J615y00 Portal cirrhosis unspecified res69: mild_liver_disease Read diagnostic
J615z00 Non-alcoholic cirrhosis NOS res69: mild_liver_disease Read diagnostic
J615z11 Macronodular cirrhosis of liver res69: mild_liver_disease Read diagnostic
J615z12 Cryptogenic cirrhosis of liver res69: mild_liver_disease Read diagnostic
J615z13 Cirrhosis of liver NOS res69: mild_liver_disease Read diagnostic
J616.00 Biliary cirrhosis res69: mild_liver_disease Read diagnostic
J616000 Primary biliary cirrhosis res69: mild_liver_disease Read diagnostic
J616100 Secondary biliary cirrhosis res69: mild_liver_disease Read diagnostic
J616z00 Biliary cirrhosis NOS res69: mild_liver_disease Read diagnostic
J617000 Chronic alcoholic hepatitis res69: mild_liver_disease Read diagnostic
J61y300 Portal fibrosis without cirrhosis res69: mild_liver_disease Read diagnostic
J633.00 Hepatitis unspecified res69: mild_liver_disease Read diagnostic
J635600 Toxic liver disease with fibrosis and cirrhosis of liver res69: mild_liver_disease Read diagnostic
Jyu7100 [X]Other and unspecified cirrhosis of liver res69: mild_liver_disease Read diagnostic
Rows: 10
Code Description Entity type Coding System (ICD-10 Read) Category
B18 Chronic viral hepatitis res69: mild_liver_disease ICD-10 diagnostic
K70.0 Alcoholic fatty liver res69: mild_liver_disease ICD-10 diagnostic
K70.1 Alcoholic hepatitis res69: mild_liver_disease ICD-10 diagnostic
K70.2 Alcoholic fibrosis and sclerosis of the liver res69: mild_liver_disease ICD-10 diagnostic
K70.3 Alcoholic cirrhosis of the liver res69: mild_liver_disease ICD-10 diagnostic
K70.9 Alcoholic liver disease, unspecified res69: mild_liver_disease ICD-10 diagnostic
K71 Toxic liver disease res69: mild_liver_disease ICD-10 diagnostic
K73 Chronic hepatitis, not elsewhere classified res69: mild_liver_disease ICD-10 diagnostic
K74 Fibrosis and cirrhosis of liver res69: mild_liver_disease ICD-10 diagnostic
K76.0 Fatty (change of) liver, not elsewhere classified res69: mild_liver_disease ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH884/version/1847/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH884/version/1847/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('PH884', '1847', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH884/version/1847/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH884/version/1847/export/codes/?format=json
CSV site_root/phenotypes/PH884/version/1847/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('PH884', '1847', api_client=client)

Version History

Version
ID
Name Owner Publish date
1847 Mild Liver Disease 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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