Print

Rheumatological 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
PH891
Version ID
1861
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: 73
Code Description Entity type Coding System (ICD-10 Read) Category
2A42.00 O/E - ankle reflex abnormal res69: rheumatological_disease Read diagnostic
F371200 Polyneuropathy in rheumatoid arthritis res69: rheumatological_disease Read diagnostic
F396100 Myopathy due to disseminated lupus erythematosus res69: rheumatological_disease Read diagnostic
F396400 Myopathy due to rheumatoid arthritis res69: rheumatological_disease Read diagnostic
F396600 Myopathy due to scleroderma res69: rheumatological_disease Read diagnostic
G5yA.00 Rheumatoid carditis res69: rheumatological_disease Read diagnostic
H570.00 Rheumatoid lung res69: rheumatological_disease Read diagnostic
H572.00 Lung disease with systemic sclerosis res69: rheumatological_disease Read diagnostic
H57y100 Lung disease with polymyositis res69: rheumatological_disease Read diagnostic
H57y400 Lung disease with systemic lupus erythematosus res69: rheumatological_disease Read diagnostic
K01x400 Nephrotic syndrome in systemic lupus erythematosus res69: rheumatological_disease Read diagnostic
K01x411 Lupus nephritis res69: rheumatological_disease Read diagnostic
N000.00 Systemic lupus erythematosus res69: rheumatological_disease Read diagnostic
N000000 Disseminated lupus erythematosus res69: rheumatological_disease Read diagnostic
N000100 Libman-Sacks disease res69: rheumatological_disease Read diagnostic
N000200 Drug-induced systemic lupus erythematosus res69: rheumatological_disease Read diagnostic
N000300 Systemic lupus erythematosus with organ or sys involv res69: rheumatological_disease Read diagnostic
N000400 Systemic lupus erythematosus with pericarditis res69: rheumatological_disease Read diagnostic
N000z00 Systemic lupus erythematosus NOS res69: rheumatological_disease Read diagnostic
N001.00 Scleroderma res69: rheumatological_disease Read diagnostic
N001.11 Acrosclerosis res69: rheumatological_disease Read diagnostic
N001.12 Systemic sclerosis res69: rheumatological_disease Read diagnostic
N001000 Progressive systemic sclerosis res69: rheumatological_disease Read diagnostic
N004.00 Polymyositis res69: rheumatological_disease Read diagnostic
N04..00 Rheumatoid arthritis and other inflammatory polyarthropathy res69: rheumatological_disease Read diagnostic
N040.00 Rheumatoid arthritis res69: rheumatological_disease Read diagnostic
N040200 Rheumatoid arthritis of shoulder res69: rheumatological_disease Read diagnostic
N040300 Rheumatoid arthritis of sternoclavicular joint res69: rheumatological_disease Read diagnostic
N040400 Rheumatoid arthritis of acromioclavicular joint res69: rheumatological_disease Read diagnostic
N040500 Rheumatoid arthritis of elbow res69: rheumatological_disease Read diagnostic
N040600 Rheumatoid arthritis of distal radio-ulnar joint res69: rheumatological_disease Read diagnostic
N040700 Rheumatoid arthritis of wrist res69: rheumatological_disease Read diagnostic
N040800 Rheumatoid arthritis of MCP joint res69: rheumatological_disease Read diagnostic
N040900 Rheumatoid arthritis of PIP joint of finger res69: rheumatological_disease Read diagnostic
N040A00 Rheumatoid arthritis of DIP joint of finger res69: rheumatological_disease Read diagnostic
N040B00 Rheumatoid arthritis of hip res69: rheumatological_disease Read diagnostic
N040C00 Rheumatoid arthritis of sacro-iliac joint res69: rheumatological_disease Read diagnostic
N040D00 Rheumatoid arthritis of knee res69: rheumatological_disease Read diagnostic
N040E00 Rheumatoid arthritis of tibio-fibular joint res69: rheumatological_disease Read diagnostic
N040F00 Rheumatoid arthritis of ankle res69: rheumatological_disease Read diagnostic
N040G00 Rheumatoid arthritis of subtalar joint res69: rheumatological_disease Read diagnostic
N040H00 Rheumatoid arthritis of talonavicular joint res69: rheumatological_disease Read diagnostic
N040J00 Rheumatoid arthritis of other tarsal joint res69: rheumatological_disease Read diagnostic
N040K00 Rheumatoid arthritis of 1st MTP joint res69: rheumatological_disease Read diagnostic
N040L00 Rheumatoid arthritis of lesser MTP joint res69: rheumatological_disease Read diagnostic
N040M00 Rheumatoid arthritis of IP joint of toe res69: rheumatological_disease Read diagnostic
N040P00 Seronegative rheumatoid arthritis res69: rheumatological_disease Read diagnostic
N040T00 Flare of rheumatoid arthritis res69: rheumatological_disease Read diagnostic
N041.00 Felty's syndrome res69: rheumatological_disease Read diagnostic
N042100 Rheumatoid lung disease res69: rheumatological_disease Read diagnostic
N047.00 Seropositive errosive rheumatoid arthritis res69: rheumatological_disease Read diagnostic
N04X.00 Seropositive rheumatoid arthritis, unspecified res69: rheumatological_disease Read diagnostic
N04y000 Rheumatoid lung res69: rheumatological_disease Read diagnostic
N04y011 Caplan's syndrome res69: rheumatological_disease Read diagnostic
N04y012 Fibrosing alveolitis associated with rheumatoid arthritis res69: rheumatological_disease Read diagnostic
N04y111 Sero negative polyarthritis res69: rheumatological_disease Read diagnostic
N060.11 Endemic polyarthritis res69: rheumatological_disease Read diagnostic
N20..00 Polymyalgia rheumatica res69: rheumatological_disease Read diagnostic
N200.00 Giant cell arteritis with polymyalgia rheumatica res69: rheumatological_disease Read diagnostic
N231400 Polymyositis ossificans res69: rheumatological_disease Read diagnostic
N240.00 Rheumatism and fibrositis unspecified res69: rheumatological_disease Read diagnostic
N240000 Rheumatism unspecified res69: rheumatological_disease Read diagnostic
N240200 Muscular rheumatism res69: rheumatological_disease Read diagnostic
N240700 Hand rheumatism res69: rheumatological_disease Read diagnostic
N240z00 Rheumatism or fibrositis NOS res69: rheumatological_disease Read diagnostic
N2y..00 Other specified nonarticular rheumatism res69: rheumatological_disease Read diagnostic
N2z..00 Nonarticular rheumatism NOS res69: rheumatological_disease Read diagnostic
Nyu1000 [X]Rheumatoid arthritis+involvement/other organs or systems res69: rheumatological_disease Read diagnostic
Nyu1100 [X]Other seropositive rheumatoid arthritis res69: rheumatological_disease Read diagnostic
Nyu1200 [X]Other specified rheumatoid arthritis res69: rheumatological_disease Read diagnostic
Nyu1G00 [X]Seropositive rheumatoid arthritis, unspecified res69: rheumatological_disease Read diagnostic
Nyu4300 [X]Other forms of systemic lupus erythematosus res69: rheumatological_disease Read diagnostic
Nyu4500 [X]Other forms of systemic sclerosis res69: rheumatological_disease Read diagnostic
Rows: 6
Code Description Entity type Coding System (ICD-10 Read) Category
D86 Sarcoidosis res69: rheumatological_disease ICD-10 diagnostic
M05 Seropositive rheumatoid arthritis res69: rheumatological_disease ICD-10 diagnostic
M06 Other rheumatoid arthritis res69: rheumatological_disease ICD-10 diagnostic
M08 Juvenile arthritis res69: rheumatological_disease ICD-10 diagnostic
M09 Juvenile arthritis in disease classified elsewhere res69: rheumatological_disease ICD-10 diagnostic
M30-M36 Systemic connective tissue disorders res69: rheumatological_disease ICD-10 diagnostic

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH891/version/1861/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH891/version/1861/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('PH891', '1861', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH891/version/1861/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH891/version/1861/export/codes/?format=json
CSV site_root/phenotypes/PH891/version/1861/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('PH891', '1861', api_client=client)

Version History

Version
ID
Name Owner Publish date
1861 Rheumatological Disease ieuan.scanlon 2022-04-04 currently shown

Export - export all codes into a csv file/JSON/XML for the current phenotype version.

Print - Print page.