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Mod Liver 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
PH885
Version ID
1849
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: 18
Code Description Entity type Coding System (ICD-10 Read) Category
760F300 Rigid oesophagoscopic injection sclerotherapy oesoph varices res69: mod_liver_disease Read diagnostic
A704z00 Other specified viral hepatitis with hepatic coma NOS res69: mod_liver_disease Read diagnostic
G85..11 Oesophageal varices res69: mod_liver_disease Read diagnostic
G850.00 Oesophageal varices with bleeding res69: mod_liver_disease Read diagnostic
G851.00 Oesophageal varices without bleeding res69: mod_liver_disease Read diagnostic
G852.00 Oesophageal varices in diseases EC res69: mod_liver_disease Read diagnostic
G852000 Oesophageal varices with bleeding in diseases EC res69: mod_liver_disease Read diagnostic
G852100 Oesophageal varices without bleeding in diseases EC res69: mod_liver_disease Read diagnostic
G852200 Oesophageal varices in cirrhosis of the liver res69: mod_liver_disease Read diagnostic
G852300 Oesophageal varices in alcoholic cirrhosis of the liver res69: mod_liver_disease Read diagnostic
G852z00 Oesophageal varices in diseases EC NOS res69: mod_liver_disease Read diagnostic
G858.00 Oesophageal varices NOS res69: mod_liver_disease Read diagnostic
Gyu9400 [X]Oesophageal varices in diseases classified elsewhere res69: mod_liver_disease Read diagnostic
J622.00 Hepatic coma res69: mod_liver_disease Read diagnostic
J623.00 Portal hypertension res69: mod_liver_disease Read diagnostic
J624.00 Hepatorenal syndrome res69: mod_liver_disease Read diagnostic
J62y.00 Other sequelae of chronic liver disease res69: mod_liver_disease Read diagnostic
J62z.00 Liver abscess and chronic liver disease causing sequelae NOS res69: mod_liver_disease Read diagnostic
Rows: 8
Code Description Entity type Coding System (ICD-10 Read) Category
B15.0 Acute hepatitis A with hepatic coma res69: mod_liver_disease ICD-10 diagnostic
B16.0 Acute hepatitis B with delta-agent (coinfection) with hepatic coma res69: mod_liver_disease ICD-10 diagnostic
B16.2 Acute hepatitis B without delta-agent with hepatic coma res69: mod_liver_disease ICD-10 diagnostic
B19.0 Unspecified viral hepatitis hepatic with coma res69: mod_liver_disease ICD-10 diagnostic
I85 Oesophageal varices res69: mod_liver_disease ICD-10 diagnostic
K70.4 Alcoholic hepatic failure res69: mod_liver_disease ICD-10 diagnostic
K72 Acute and subacute hepatic failure res69: mod_liver_disease ICD-10 diagnostic
K76.6 Portal hypertension res69: mod_liver_disease ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH885/version/1849/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH885/version/1849/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('PH885', '1849', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH885/version/1849/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH885/version/1849/export/codes/?format=json
CSV site_root/phenotypes/PH885/version/1849/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('PH885', '1849', api_client=client)

Version History

Version
ID
Name Owner Publish date
1849 Mod 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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