Olena O Seminog

Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage:

Background Psychiatric illnesses are known risk factors for self-harm but associations between self-harm and physical illnesses are less well established. We aimed to stratify selected chronic physical and psychiatric illnesses according to their relative risk of self-harm. Design Retrospective cohort studies using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011. Participants Individuals with selected psychiatric or physical conditions were compared with a reference cohort constructed from patients admitted for a variety of other conditions and procedures. Setting All admissions and day cases in National Health Service (NHS) hospitals in England. Main outcome measures Hospital episodes of self-harm. Rate ratios (RRs) were derived by comparing admission for self-harm between cohorts. Results The psychiatric illnesses studied (depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse) all had very high RRs (> 5) for self-harm. Of the physical illnesses studied, an increased risk of self-harm was associated with epilepsy (RR = 2.9, 95% confidence interval [CI] 2.8–2.9), asthma (1.8, 1.8–1.9), migraine (1.8, 1.7–1.8), psoriasis (1.6, 1.5–1.7), diabetes mellitus (1.6, 1.5–1.6), eczema (1.4, 1.3–1.5) and inflammatory polyarthropathies (1.4, 1.3–1.4). RRs were significantly low for cancers (0.95, 0.93–0.97), congenital heart disease (0.9, 0.8–0.9), ulcerative colitis (0.8, 0.7–0.8), sickle cell anaemia (0.7, 0.6–0.8) and Downs syndrome (0.1, 0.1–0.2). Conclusions Psychiatric illnesses carry a greatly increased risk of self-harm as well as of suicide. Many chronic physical illnesses are also associated with an increased risk of both self-harm and suicide. Identifying those at risk will allow provision of appropriate monitoring and support.

Risk of benign tumours of nervous system, and of malignant neoplasms, in people with neurofibromatosis: population-based record-linkage study

Background:The neurofibromatoses (NF) are genetic disorders. Increased risks of some cancers in people with NF are well recognised, but there is no comprehensive enumeration of the risks across the whole range of site-specific cancers. Our aim was to provide this.Methods:A linked data set of hospital admissions and deaths in England was used to compare rates of tumours in an NF cohort with rates in a comparison cohort, with results expressed as rate ratios (RR).Results:The RR for all cancers combined, in people with both types of NF combined, was 4.3 (95% confidence interval (CI): 4.0–4.6), based on 769 cases of cancer in 8003 people with NF. Considering only people with presumed NF1 (as defined in the main article), the RR for all cancers excluding nervous system malignancies remained elevated (2.7, 95% CI: 2.4–2.9); and risks were significantly high for cancer of the oesophagus (3.3), stomach (2.8), colon (2.0), liver (3.8), lung (3.0), bone (19.6), thyroid (4.9), malignant melanoma (3.6), non-Hodgkin’s lymphoma (3.3), chronic myeloid leukaemia (6.7), female breast (2.3) and ovary (3.7).Conclusion:Neurofibromatosis was associated with an increased risk of many individual cancers. The relationships between NF and cancers may hold clues to mechanisms of carcinogenesis more generally.

Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies

OBJECTIVE Some studies suggest that gout is a risk factor for cardiovascular disease. There is more evidence about the association between gout and acute myocardial infarction (MI) than about gout and stroke, and only limited information about risks by age group and sex. We aimed to study MI and stroke following gout, including types of stroke, by age group and comparing men and women. METHODS We analysed an all-England national linked dataset of hospital admissions and death records from 1999 to 2011, and a similar dataset in the Oxford Record Linkage Study spanning 1963-98. The occurrence of MI and stroke was estimated in cohorts of patients admitted to hospital with gout, compared with MI and stroke in control cohorts, and the comparisons were expressed as rate ratios (RRs). RESULTS The risk of MI and stroke was elevated, and similar, in both datasets. In the all-England dataset, which included 202 033 hospital patients with gout, the RR for MI following gout was 1.82 (95% CI 1.78, 1.85), for all stroke 1.71 (1.68, 1.75), ischaemic stroke 1.68 (1.64, 1.73), haemorrhagic stroke 1.69 (1.61, 1.77) and stroke of unspecified type 2.00 (1.95, 2.06). Associations were stronger in younger than older age groups, and in the younger were stronger in women than men. CONCLUSION Gout was associated with increased risk of stroke as well as MI. These findings should be considered by clinicians and may have implications for preventive management of circulatory disease risks in people with gout.

Associations between Klinefelter's syndrome and autoimmune diseases: English national record linkage studies.

Abstract There are reports suggesting that people with Klinefelter’s syndrome (KS) may be at increased risk of some autoimmune diseases, but the evidence is not substantial. We wanted to add to the evidence by systematically assessing the risk of autoimmune diseases in a national cohort of people with KS. We selected records of all people with KS in a record-linked dataset of all hospital day cases and inpatient admissions in England, 1999–2011; and we followed them up by electronic record linkage to identify the occurrence of autoimmune diseases. We compared their occurrence in the KS cohort with a control cohort, studied in the same way, and expressed the results as rate ratios (RR). Of 30 autoimmune diseases studied in people with KS, there were significantly increased risks of seven–Addison’s disease (RR 11.7, 95% confidence interval 2.4–34.4), diabetes mellitus type 1 (6.1, 4.4–8.3), multiple sclerosis (4.3, 1.2–11.0), acquired hypothyroidism (2.7, 1.8–4.0), rheumatoid arthritis (3.3, 2.0–5.2), Sjogren’s syndrome (19.3, 4.0–57.0) and systemic lupus erythematosus (18.1, 2.2–65.6). We concluded that people with KS have increased risk of some autoimmune diseases, particularly those that are female-predominant. The increased risk of autoimmune diseases associated with the XXY karyotype may hold clues to the pathogenesis of some aspects of autoimmunity.

Risk of pneumonia and pneumococcal disease in people with severe mental illness: English record linkage studies

Background People with severe mental illness have a higher risk than others of some physical diseases. The risk of pneumococcal disease in people with mental disorders is unknown. This is potentially important because vaccines against the pneumococcus are available. Methods We used two datasets of linked hospital admission and death records, the Oxford Record Linkage Study and all-England linked Hospital Episode Statistics, to estimate the risk of lobar pneumonia and other pneumococcal disease (here, all collectively termed pneumococcal disease) in people hospitalised with schizophrenia, bipolar disorder, depression or anxiety. We compared rates of pneumococcal disease in each cohort with rates in a comparison cohort of people without a record of hospitalisation for these psychiatric disorders. Findings The risk of pneumococcal disease in each psychiatric group was significantly high in both datasets. In the English national dataset (spanning 1999–2011), the risk of pneumococcal disease in people hospitalised with schizophrenia, bipolar disorder, depression or anxiety was, respectively, 2.3 (95% CI 2.2 to 2.4), 2.3 (2.2 to 2.3), 2.1 (2.0 to 2.1) and 2.2 (2.1 to 2.2). The risk remained high for years after discharge, suggesting an association with the psychiatric disorder rather than with the event of hospitalisation. Conclusions Severe mental illness is a risk factor for lobar pneumonia, pneumococcal pneumonia, pneumococcal septicaemia and meningitis. Possible explanations for the elevated risk include factors relating to lifestyle and health-risk activities. If our findings are replicated elsewhere, there would be a case for considering routine pneumococcal immunisation for people with severe mental illness.

Age-specific risk of breast cancer in women with neurofibromatosis type 1.

Background:Young women with neurofibromatosis type 1 (NF1) are reported to have a higher risk of breast cancer than others, and this might have implications for screening programmes. Our aim was to calculate this risk.Methods:An all-England linked data set of hospital admissions and deaths was analysed to determine age-specific rates of breast cancer in women with NF1 and controls.Results:The age-specific excess risk of breast cancer, comparing the NF1 cohort with the control cohort, was elevated 6.5-fold (95% confidence interval 2.6–13.5) in women aged 30–39 years. There was a 4.4 (2.5–7.0) times higher risk among women aged 40–49.Conclusions:Women with NF1 develop breast cancer at younger ages than the general population.

Turner syndrome and autoimmune diseases: record-linkage study

Background There is increasing evidence that Turner syndrome is associated with an elevated risk of a range of autoimmune disorders. We aimed to document this in a national study. Method Use of a record-linked dataset of all hospital admissions in England, 1999–2011, to construct a retrospective cohort of people with Turner syndrome and a control cohort of people without it. Statistical follow-up to identify the occurrence of 29 separate autoimmune disorders in each cohort. Calculation of rate ratios, comparing the Turner and control cohorts. Results In the Turner syndrome cohort (2459 people), rate ratios were elevated for 16 of the 29 conditions. Examples included coeliac disease (rate ratio 14.0, 95% CI 10.2 to 18.8), Crohns disease (5.3, 3.5 to 7.8), ulcerative colitis (3.9, 2.3 to 6.1), hypothyroidism (8.8, 7.8 to 9.9) and hyperthyroidism (4.9, 3.2 to 7.1). Conclusions The increased risk of autoimmune disorders in people with Turner syndrome covers a wide range of conditions.

Risk of fractures in patients with multiple sclerosis: record-linkage study

BackgroundPatients with multiple sclerosis (MS) have been reported to be at higher risk of fracture than other people. We sought to test this hypothesis in a large database of hospital admissions in England.MethodsWe analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999–2010). Rate ratios for fractures were determined, comparing fracture rates in a cohort of all people in England admitted with MS and rates in a comparison cohort.ResultsSignificantly elevated risk for all fractures was found in patients with MS (rate ratio (RR) = 1.99, 95% confidence interval (CI) = 1.93-2.05)). Risks were particularly high for femoral fractures (femoral neck fracture RR = 2.79 (2.65-2.93); femoral shaft fracture RR 6.69 (6.12-7.29)), and fractures of the tibia or ankle RR = 2.81 (2.66-2.96).ConclusionsPatients with MS have an increased risk of fractures. Caregivers should aim to optimize bone health in MS patients.

Risk of pneumonia and pneumococcal disease in people hospitalized with diabetes mellitus: English record-linkage studies

The risk of invasive pneumococcal disease is higher in people with diabetes mellitus than those without. People with diabetes should be considered for routine pneumococcal immunization. This policy has been in place in England for more than a decade. We aimed to estimate, at the population level, the current scale of excess risk of pneumococcal disease in patients with diabetes, and whether the risks have decreased in recent years with the introduction of a pneumococcal vaccine.

Risk of subarachnoid haemorrhage in people admitted to hospital with selected immune-mediated diseases: record-linkage studies.

BackgroundSubarachnoid hemorrhage (SAH) is a devastating cause of stroke, occurring in relatively young people. It has been suggested that some immune-mediated diseases may be associated with an increased risk of SAH.MethodsWe analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999–2011). Rate ratios for SAH were determined, comparing immune-mediated disease cohorts with comparison cohorts.ResultsThere were significantly elevated risks of SAH after hospital admission for the following individual immune-mediated diseases: Addison’s disease, ankylosing spondylitis, autoimmune haemolytic anaemia, Crohn’s disease, diabetes mellitus, idiopathic thrombocytopenia purpura, myxoedema, pernicious anaemia, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, scleroderma, Sjogren’s syndrome, SLE and thyrotoxicosis. Elevated risks that were greater than 2-fold were found for Addison’s disease (rate ratio (RR) = 2.01, 95% confidence interval 1.3-2.97), idiopathic thrombocytopenia purpura (RR = 2.42, 1.86-3.11), primary biliary cirrhosis (RR = 2.21, 1.43-3.16) and SLE (RR = 3.76, 3.08-4.55).ConclusionsOur findings strongly support the suggestion that patients with some immune-mediated diseases have an increased risk of SAH. Further studies of the mechanisms behind this association are warranted.