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Peripheral Vascular

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

Type
Disease or Syndrome
ID
PH888
Version ID
1855
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: 51
Code Description Entity type Coding System (ICD-10 Read) Category
14AE.00 H/O: aortic aneurysm res69: peripheral_vascular Read diagnostic
14NB.00 H/O: Peripheral vascular disease procedure res69: peripheral_vascular Read diagnostic
2I16.00 O/E - gangrene res69: peripheral_vascular Read diagnostic
7A11211 Y graft of abdominal Aortic aneurysm (emergency) res69: peripheral_vascular Read diagnostic
7A11311 Y graft abdominal Aortic aneurysm res69: peripheral_vascular Read diagnostic
7A13.11 Emergency repair of aortic aneurysm res69: peripheral_vascular Read diagnostic
7A13411 Tube graft abdominal Aortic aneurysm (emergency) res69: peripheral_vascular Read diagnostic
7A14.11 Aortic aneurysm repair res69: peripheral_vascular Read diagnostic
7A14411 Tube graft of Abdominal aortic aneurysm res69: peripheral_vascular Read diagnostic
C107.12 Diabetes with gangrene res69: peripheral_vascular Read diagnostic
G71..00 Aortic aneurysm res69: peripheral_vascular Read diagnostic
G710.00 Dissecting aortic aneurysm res69: peripheral_vascular Read diagnostic
G711.00 Thoracic aortic aneurysm which has ruptured res69: peripheral_vascular Read diagnostic
G711.11 Ruptured thoracic aortic aneurysm res69: peripheral_vascular Read diagnostic
G712.00 Thoracic aortic aneurysm without mention of rupture res69: peripheral_vascular Read diagnostic
G713.00 Abdominal aortic aneurysm which has ruptured res69: peripheral_vascular Read diagnostic
G713.11 Ruptured abdominal aortic aneurysm res69: peripheral_vascular Read diagnostic
G713000 Ruptured suprarenal aortic aneurysm res69: peripheral_vascular Read diagnostic
G714.00 Abdominal aortic aneurysm without mention of rupture res69: peripheral_vascular Read diagnostic
G714.11 AAA - Abdominal aortic aneurysm without mention of rupture res69: peripheral_vascular Read diagnostic
G714000 Juxtarenal aortic aneurysm res69: peripheral_vascular Read diagnostic
G714100 Inflammatory abdominal aortic aneurysm res69: peripheral_vascular Read diagnostic
G715.00 Ruptured aortic aneurysm NOS res69: peripheral_vascular Read diagnostic
G715000 Thoracoabdominal aortic aneurysm, ruptured res69: peripheral_vascular Read diagnostic
G716.00 Aortic aneurysm without mention of rupture NOS res69: peripheral_vascular Read diagnostic
G716000 Thoracoabdominal aortic aneurysm, without mention of rupture res69: peripheral_vascular Read diagnostic
G718.00 Leaking abdominal aortic aneurysm res69: peripheral_vascular Read diagnostic
G71z.00 Aortic aneurysm NOS res69: peripheral_vascular Read diagnostic
G73..00 Other peripheral vascular disease res69: peripheral_vascular Read diagnostic
G73..11 Peripheral ischaemic vascular disease res69: peripheral_vascular Read diagnostic
G731100 Presenile gangrene res69: peripheral_vascular Read diagnostic
G732.00 Peripheral gangrene res69: peripheral_vascular Read diagnostic
G732000 Gangrene of toe res69: peripheral_vascular Read diagnostic
G732100 Gangrene of foot res69: peripheral_vascular Read diagnostic
G732200 Gangrene of finger res69: peripheral_vascular Read diagnostic
G732300 Gangrene of thumb res69: peripheral_vascular Read diagnostic
G732400 Gangrene of hand res69: peripheral_vascular Read diagnostic
G73y.00 Other specified peripheral vascular disease res69: peripheral_vascular Read diagnostic
G73yz00 Other specified peripheral vascular disease NOS res69: peripheral_vascular Read diagnostic
G73z.00 Peripheral vascular disease NOS res69: peripheral_vascular Read diagnostic
G73z000 Intermittent claudication res69: peripheral_vascular Read diagnostic
G73z011 Claudication res69: peripheral_vascular Read diagnostic
G73zz00 Peripheral vascular disease NOS res69: peripheral_vascular Read diagnostic
Gyu7100 [X]Aortic aneurysm of unspecified site, ruptured res69: peripheral_vascular Read diagnostic
Gyu7200 [X]Aortic aneurysm of unspecified site, nonruptured res69: peripheral_vascular Read diagnostic
Gyu7400 [X]Other specified peripheral vascular diseases res69: peripheral_vascular Read diagnostic
R054.00 [D]Gangrene res69: peripheral_vascular Read diagnostic
R054000 [D]Gangrene, spreading cutaneous res69: peripheral_vascular Read diagnostic
R054200 [D]Gangrene of toe in diabetic res69: peripheral_vascular Read diagnostic
R054300 [D]Widespread diabetic foot gangrene res69: peripheral_vascular Read diagnostic
R054z00 [D]Gangrene NOS res69: peripheral_vascular Read diagnostic
Rows: 6
Code Description Entity type Coding System (ICD-10 Read) Category
I70 Atherosclerosis res69: peripheral_vascular ICD-10 diagnostic
I71 Aortic aneurysm and dissection res69: peripheral_vascular ICD-10 diagnostic
I72 Other aneurysm res69: peripheral_vascular ICD-10 diagnostic
I73 Other peripheral vascular diseases res69: peripheral_vascular ICD-10 diagnostic
I74 Arterial embolism and thrombosis res69: peripheral_vascular ICD-10 diagnostic
I77 Other disorders of arteries and arterioles res69: peripheral_vascular ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH888/version/1855/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH888/version/1855/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('PH888', '1855', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH888/version/1855/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH888/version/1855/export/codes/?format=json
CSV site_root/phenotypes/PH888/version/1855/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('PH888', '1855', api_client=client)

Version History

Version
ID
Name Owner Publish date
1855 Peripheral Vascular ieuan.scanlon 2022-04-04 currently shown

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