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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: smoking
62 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 137..00 | Read | Tobacco consumption | diagnostic | res41: smoking | |||
| 1371.00 | Read | Never smoked tobacco | diagnostic | res41: smoking | |||
| 137..11 | Read | Smoker - amount smoked | diagnostic | res41: smoking | |||
| 1371.11 | Read | Non-smoker | diagnostic | res41: smoking | |||
| 1372.00 | Read | Trivial smoker - < 1 cig/day | diagnostic | res41: smoking | |||
| 1372.11 | Read | Occasional smoker | diagnostic | res41: smoking | |||
| 1373.00 | Read | Light smoker - 1-9 cigs/day | diagnostic | res41: smoking | |||
| 1374.00 | Read | Moderate smoker - 10-19 cigs/d | diagnostic | res41: smoking | |||
| 1375.00 | Read | Heavy smoker - 20-39 cigs/day | diagnostic | res41: smoking | |||
| 1376.00 | Read | Very heavy smoker - 40+cigs/d | diagnostic | res41: smoking | |||
| 1377.00 | Read | Ex-trivial smoker (<1/day) | diagnostic | res41: smoking | |||
| 1378.00 | Read | Ex-light smoker (1-9/day) | diagnostic | res41: smoking | |||
| 1379.00 | Read | Ex-moderate smoker (10-19/day) | diagnostic | res41: smoking | |||
| 137a.00 | Read | Pipe tobacco consumption | diagnostic | res41: smoking | |||
| 137A.00 | Read | Ex-heavy smoker (20-39/day) | diagnostic | res41: smoking | |||
| 137b.00 | Read | Ready to stop smoking | diagnostic | res41: smoking | |||
| 137B.00 | Read | Ex-very heavy smoker (40+/day) | diagnostic | res41: smoking | |||
| 137c.00 | Read | Thinking about stopping smoking | diagnostic | res41: smoking | |||
| 137C.00 | Read | Keeps trying to stop smoking | diagnostic | res41: smoking | |||
| 137d.00 | Read | Not interested in stopping smoking | diagnostic | res41: smoking | |||
| 137D.00 | Read | Admitted tobacco cons untrue ? | diagnostic | res41: smoking | |||
| 137e.00 | Read | Smoking restarted | diagnostic | res41: smoking | |||
| 137E.00 | Read | Tobacco consumption unknown | diagnostic | res41: smoking | |||
| 137F.00 | Read | Ex-smoker - amount unknown | diagnostic | res41: smoking | |||
| 137G.00 | Read | Trying to give up smoking | diagnostic | res41: smoking | |||
| 137H.00 | Read | Pipe smoker | diagnostic | res41: smoking | |||
| 137I.00 | Read | Passive smoker | diagnostic | res41: smoking | |||
| 137j.00 | Read | Ex-cigarette smoker | diagnostic | res41: smoking | |||
| 137J.00 | Read | Cigar smoker | diagnostic | res41: smoking | |||
| 137K.00 | Read | Stopped smoking | diagnostic | res41: smoking | |||
| 137K000 | Read | Recently stopped smoking | diagnostic | res41: smoking | |||
| 137l.00 | Read | Ex roll-up cigarette smoker | diagnostic | res41: smoking | |||
| 137L.00 | Read | Current non-smoker | diagnostic | res41: smoking | |||
| 137m.00 | Read | Failed attempt to stop smoking | diagnostic | res41: smoking | |||
| 137M.00 | Read | Rolls own cigarettes | diagnostic | res41: smoking | |||
| 137N.00 | Read | Ex pipe smoker | diagnostic | res41: smoking | |||
| 137O.00 | Read | Ex cigar smoker | diagnostic | res41: smoking | |||
| 137P.00 | Read | Cigarette smoker | diagnostic | res41: smoking | |||
| 137P.11 | Read | Smoker | diagnostic | res41: smoking | |||
| 137Q.00 | Read | Smoking started | diagnostic | res41: smoking | |||
| 137Q.11 | Read | Smoking restarted | diagnostic | res41: smoking | |||
| 137R.00 | Read | Current smoker | diagnostic | res41: smoking | |||
| 137S.00 | Read | Ex smoker | diagnostic | res41: smoking | |||
| 137T.00 | Read | Date ceased smoking | diagnostic | res41: smoking | |||
| 137U.00 | Read | Not a passive smoker | diagnostic | res41: smoking | |||
| 137V.00 | Read | Smoking reduced | diagnostic | res41: smoking | |||
| 137W.00 | Read | Chews tobacco | diagnostic | res41: smoking | |||
| 137X.00 | Read | Cigarette consumption | diagnostic | res41: smoking | |||
| 137Y.00 | Read | Cigar consumption | diagnostic | res41: smoking | |||
| 137Z.00 | Read | Tobacco consumption NOS | diagnostic | res41: smoking | |||
| 8CAL.00 | Read | Smoking cessation advice | diagnostic | res41: smoking | |||
| 8H7i.00 | Read | Referral to smoking cessation advisor | diagnostic | res41: smoking | |||
| 8HkQ.00 | Read | Referral to NHS stop smoking service | diagnostic | res41: smoking | |||
| 8HTK.00 | Read | Referral to stop-smoking clinic | diagnostic | res41: smoking | |||
| 8IAj.00 | Read | Smoking cessation advice declined | diagnostic | res41: smoking | |||
| 9km..00 | Read | Ex-smoker annual review - enhanced services administration | diagnostic | res41: smoking | |||
| 9km..11 | Read | Ex-smoker annual review | diagnostic | res41: smoking | |||
| 9kn..00 | Read | Non-smoker annual review - enhanced services administration | diagnostic | res41: smoking | |||
| 9kn..11 | Read | Non-smoker annual review | diagnostic | res41: smoking | |||
| 9ko..00 | Read | Current smoker annual review - enhanced services admin | diagnostic | res41: smoking | |||
| 9ko..11 | Read | Current smoker annual review | diagnostic | res41: smoking | |||
| 9NS0200 | Read | Referral for smoking cessation service offered | diagnostic | res41: smoking |
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