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Research article:
Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm
Reference:
Matthew J. Carr, Darren M. Ashcroft, Evangelos Kontopantelis, David While, Yvonne Awenat, Jayne Cooper, Carolyn Chew-Graham, Nav Kapur, Roger T. Webb (2016) Short- and long-term risk of premature death in a nationally representative cohort of primary care patients with history of self-harm. BMJ, doi:
- Link to article
- Abstract
- Objectives: To examine premature mortality in a nationally representative cohort of primary care patients who have harmed themselves, and to estimate relative risks versus the general population stratified by follow-up time from first to tenth year. Design: Matched cohort study. Setting: 385 general practices in England contributing data to the Clinical Practice Research Datalink (CPRD) during 2001-2013 with linkage to national mortality records. Population: Index cohort of 30,017 persons aged 15-64 years with a record of self-harm; comparison cohort, sampled from the same population, consisting of 600,258 persons with no record of self-harm and matched to index patients on age (year of birth), gender and registered general practice. Main outcome measures: Hazards ratios for all-cause and cause-specific mortality, including unnatural vs. natural death, suicide, intentional vs. accidental poisoning, and alcohol-related death. Results: We found greatly raised risk of dying prematurely from any cause among members of the self-harm cohort, especially so during the first follow-up year: hazard ratio (HR) 9.9, 95% confidence interval (CI) 8.6 to 11.4. The elevation in suicide risk within a year was especially great (HR 113.9, CI 73.9 to 175.6). Beyond the first follow-up year, suicide risk declined sharply but remained much higher than in the comparison cohort. Large risk elevations throughout the follow-up period were observed for accidental self-poisoning and alcohol-related death. Conclusions: Primary care patients who have harmed themselves are at greatly increased risk of dying prematurely by suicide and by other causes, and especially so within a year of the index episode. Relatively frequent general practice attendance by these individuals presents a clear opportunity for preventive action in primary care. National clinical guidelines could provide more specific recommendations for how primary healthcare teams can monitor, intervene and manage risk in these patients more effectively.
- Author for correspondence
- Matthew J Carr
- Email for correspondence
- matthew.carr@manchester.ac.uk
Code list: res41: alcohol
99 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1282.00 | Read | fh: alcoholism | diagnostic | res41: alcohol | |||
| 1366.00 | Read | Very heavy drinker - >9u/day | diagnostic | res41: alcohol | |||
| 136Q.00 | Read | Very heavy drinker | diagnostic | res41: alcohol | |||
| 136T.00 | Read | harmful alcohol use | diagnostic | res41: alcohol | |||
| 1462.00 | Read | H/O: alcoholism | diagnostic | res41: alcohol | |||
| 1B1c.00 | Read | Alcohol induced hallucinations | diagnostic | res41: alcohol | |||
| 66e0.00 | Read | alcohol abuse monitoring | diagnostic | res41: alcohol | |||
| 7P22100 | Read | Delivery of rehabilitation for alcohol addiction | diagnostic | res41: alcohol | |||
| 8BA8.00 | Read | alcohol detoxification | diagnostic | res41: alcohol | |||
| 8CAv.00 | Read | advised to contact primary care alcohol worker | diagnostic | res41: alcohol | |||
| 8G32.00 | Read | Aversion therapy - alcoholism | diagnostic | res41: alcohol | |||
| 8H35.00 | Read | admitted to alcohol detoxification centre | diagnostic | res41: alcohol | |||
| 8HkG.00 | Read | Referral to specialist alcohol treatment service | diagnostic | res41: alcohol | |||
| 8IAF.00 | Read | brief intervention for excessive alcohol consumptn declined | diagnostic | res41: alcohol | |||
| 8IAJ.00 | Read | declined referral to specialist alcohol treatment service | diagnostic | res41: alcohol | |||
| 8IAt.00 | Read | Extended intervention for excessive alcohol consumption declined | diagnostic | res41: alcohol | |||
| 9k1B.00 | Read | Extended intervention for excessive alcohol consumption completed | diagnostic | res41: alcohol | |||
| 9NN2.00 | Read | Under care of community alcohol team | diagnostic | res41: alcohol | |||
| C150500 | Read | Alcohol-induced pseudo-Cushing's syndrome | diagnostic | res41: alcohol | |||
| E01..00 | Read | Alcoholic psychoses | diagnostic | res41: alcohol | |||
| E010.00 | Read | Alcohol withdrawal delirium | diagnostic | res41: alcohol | |||
| E011000 | Read | Korsakov's alcoholic psychosis | diagnostic | res41: alcohol | |||
| E011100 | Read | Korsakov's alcoholic psychosis with peripheral neuritis | diagnostic | res41: alcohol | |||
| E011200 | Read | Wernicke-Korsakov syndrome | diagnostic | res41: alcohol | |||
| E011z00 | Read | Alcohol amnestic syndrome NOS | diagnostic | res41: alcohol | |||
| E012.00 | Read | Other alcoholic dementia | diagnostic | res41: alcohol | |||
| E012000 | Read | Chronic alcoholic brain syndrome | diagnostic | res41: alcohol | |||
| E012.11 | Read | alcoholic dementia nos | diagnostic | res41: alcohol | |||
| E013.00 | Read | Alcohol withdrawal hallucinosis | diagnostic | res41: alcohol | |||
| E014.00 | Read | pathological alcohol intoxication | diagnostic | res41: alcohol | |||
| E015.00 | Read | Alcoholic paranoia | diagnostic | res41: alcohol | |||
| E01y.00 | Read | Other alcoholic psychosis | diagnostic | res41: alcohol | |||
| E01y000 | Read | Alcohol withdrawal syndrome | diagnostic | res41: alcohol | |||
| E01yz00 | Read | Other alcoholic psychosis NOS | diagnostic | res41: alcohol | |||
| E01z.00 | Read | Alcoholic psychosis NOS | diagnostic | res41: alcohol | |||
| E23..00 | Read | Alcohol dependence syndrome | diagnostic | res41: alcohol | |||
| E230.00 | Read | Acute alcoholic intoxication in alcoholism | diagnostic | res41: alcohol | |||
| E230000 | Read | Acute alcoholic intoxication, unspecified, in alcoholism | diagnostic | res41: alcohol | |||
| E230100 | Read | Continuous acute alcoholic intoxication in alcoholism | diagnostic | res41: alcohol | |||
| E230.11 | Read | alcohol dependence with acute alcoholic intoxication | diagnostic | res41: alcohol | |||
| E230200 | Read | Episodic acute alcoholic intoxication in alcoholism | diagnostic | res41: alcohol | |||
| E230300 | Read | Acute alcoholic intoxication in remission, in alcoholism | diagnostic | res41: alcohol | |||
| E230z00 | Read | Acute alcoholic intoxication in alcoholism NOS | diagnostic | res41: alcohol | |||
| E231.00 | Read | Chronic alcoholism | diagnostic | res41: alcohol | |||
| E231000 | Read | Unspecified chronic alcoholism | diagnostic | res41: alcohol | |||
| E23..11 | Read | Alcoholism | diagnostic | res41: alcohol | |||
| E231100 | Read | Continuous chronic alcoholism | diagnostic | res41: alcohol | |||
| E231200 | Read | Episodic chronic alcoholism | diagnostic | res41: alcohol | |||
| E231300 | Read | Chronic alcoholism in remission | diagnostic | res41: alcohol | |||
| E231z00 | Read | Chronic alcoholism NOS | diagnostic | res41: alcohol | |||
| E23z.00 | Read | Alcohol dependence syndrome NOS | diagnostic | res41: alcohol | |||
| E250300 | Read | nondependent alcohol abuse in remission | diagnostic | res41: alcohol | |||
| Eu10.00 | Read | [X]Mental and behavioural disorders due to use of alcohol | diagnostic | res41: alcohol | |||
| Eu10100 | Read | [x]mental and behav dis due to use of alcohol: harmful use | diagnostic | res41: alcohol | |||
| Eu10200 | Read | [X]Mental and behavioural disorders due to use of alcohol: dependence syndrome | diagnostic | res41: alcohol | |||
| Eu10211 | Read | [x]alcohol addiction | diagnostic | res41: alcohol | |||
| Eu10212 | Read | [x]chronic alcoholism | diagnostic | res41: alcohol | |||
| Eu10300 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state | diagnostic | res41: alcohol | |||
| Eu10400 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state with delirium | diagnostic | res41: alcohol | |||
| Eu10411 | Read | [x]delirium tremens, alcohol induced | diagnostic | res41: alcohol | |||
| Eu10500 | Read | [X]Mental and behavioural disorders due to use of alcohol: psychotic disorder | diagnostic | res41: alcohol | |||
| Eu10511 | Read | [X]Alcoholic hallucinosis | diagnostic | res41: alcohol | |||
| Eu10512 | Read | [x]alcoholic jealousy | diagnostic | res41: alcohol | |||
| Eu10513 | Read | [X]Alcoholic paranoia | diagnostic | res41: alcohol | |||
| Eu10514 | Read | [X]Alcoholic psychosis NOS | diagnostic | res41: alcohol | |||
| Eu10600 | Read | [X]Mental and behavioural disorders due to use of alcohol: amnesic syndrome | diagnostic | res41: alcohol | |||
| Eu10611 | Read | [x]korsakov's psychosis, alcohol induced | diagnostic | res41: alcohol | |||
| Eu10700 | Read | [X]Mental and behavioural disorders due to use of alcohol: residual and late-onset psychotic disorde | diagnostic | res41: alcohol | |||
| Eu10711 | Read | [X]Alcoholic dementia NOS | diagnostic | res41: alcohol | |||
| Eu10712 | Read | [X]Chronic alcoholic brain syndrome | diagnostic | res41: alcohol | |||
| Eu10800 | Read | [X]Alcohol withdrawal-induced seizure | diagnostic | res41: alcohol | |||
| Eu10y00 | Read | [X]Mental and behavioural disorders due to use of alcohol: other mental and behavioural disorders | diagnostic | res41: alcohol | |||
| Eu10z00 | Read | [X]Mental and behavioural disorders due to use of alcohol: unspecified mental and behavioural disord | diagnostic | res41: alcohol | |||
| F11x000 | Read | Cerebral degeneration due to alcoholism | diagnostic | res41: alcohol | |||
| F11x011 | Read | Alcoholic encephalopathy | diagnostic | res41: alcohol | |||
| F144000 | Read | Cerebellar ataxia due to alcoholism | diagnostic | res41: alcohol | |||
| F25B.00 | Read | Alcohol-induced epilepsy | diagnostic | res41: alcohol | |||
| F375.00 | Read | Alcoholic polyneuropathy | diagnostic | res41: alcohol | |||
| F394100 | Read | Alcoholic myopathy | diagnostic | res41: alcohol | |||
| G555.00 | Read | Alcoholic cardiomyopathy | diagnostic | res41: alcohol | |||
| G852300 | Read | Oesophageal varices in alcoholic cirrhosis of the liver | diagnostic | res41: alcohol | |||
| J610.00 | Read | Alcoholic fatty liver | diagnostic | res41: alcohol | |||
| J611.00 | Read | Acute alcoholic hepatitis | diagnostic | res41: alcohol | |||
| J612.00 | Read | Alcoholic cirrhosis of liver | diagnostic | res41: alcohol | |||
| J612000 | Read | Alcoholic fibrosis and sclerosis of liver | diagnostic | res41: alcohol | |||
| J613.00 | Read | Alcoholic liver damage unspecified | diagnostic | res41: alcohol | |||
| J613000 | Read | Alcoholic hepatic failure | diagnostic | res41: alcohol | |||
| J617.00 | Read | Alcoholic hepatitis | diagnostic | res41: alcohol | |||
| J617000 | Read | Chronic alcoholic hepatitis | diagnostic | res41: alcohol | |||
| J671000 | Read | Alcohol-induced chronic pancreatitis | diagnostic | res41: alcohol | |||
| SLH3.00 | Read | Alcohol deterrent poisoning | diagnostic | res41: alcohol | |||
| SM00100 | Read | denatured alcohol causing toxic effect | diagnostic | res41: alcohol | |||
| U60H300 | Read | [X]Alcohol deterrents causing adverse effects in therapeutic use | diagnostic | res41: alcohol | |||
| U60H311 | Read | [X] Adverse reaction to alcohol deterrents | diagnostic | res41: alcohol | |||
| Z191.00 | Read | alcohol detoxification | diagnostic | res41: alcohol | |||
| Z191100 | Read | alcohol withdrawal regime | diagnostic | res41: alcohol | |||
| Z191211 | Read | alcohol reduction programme | diagnostic | res41: alcohol | |||
| ZR1E.11 | Read | ads - alcohol dependence scale | diagnostic | res41: alcohol | |||
| ZV11300 | Read | [V]Personal history of alcoholism | diagnostic | res41: alcohol |
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