Citation

Thomas KH, Davies N, Metcalfe C, Windmeijer F, Martin RM, Gunnell D. Br. J. Clin. Pharmacol. 2013; 76(1): 145-157.

Affiliation

University of Bristol.

Copyright

(Copyright © 2013, John Wiley and Sons)

DOI

10.1111/bcp.12059

PMID

23216533

Abstract

AIMS: The UK's Clinical Practice Research Datalink (CPRD) is increasingly used to investigate suicide- related adverse drug reactions. No studies have comprehensively validated the recording of suicide and non-fatal self-harm in the CPRD. We validated GP's recording of these outcomes using linked Office for National Statistics (ONS) mortality and hospital episode statistics (HES) admission data. METHODS: We identified cases of suicide and self-harm recorded using appropriate Read codes in the CPRD between 1998 and 2010 in patients aged ≥ 15 years. Suicides were defined as patients with Read codes for suicide recorded within 95 days of their death. ICD codes were used to identify suicides/hospital admissions for self-harm in the linked ONS and HES datasets. We compared CPRD derived cases/incidence of suicide and self-harm with those identified from linked ONS mortality and HES data, national suicide incidence rates and published self-harm incidence data. RESULTS: Only 26.1% (n=590) of the 'true' (ONS-confirmed) suicides were identified using Read codes. Furthermore, only 55.5% of Read code identified suicides were confirmed as suicide by the ONS data. 68.4% of HES-identified cases of self-harm were identified in the CPRD using Read codes. CPRD self-harm rates based on Read codes had similar age and sex distributions to rates observed in self-harm hospital registers although rates were underestimated in all age groups. CONCLUSIONS: CPRD recording of suicide using Read codes is unreliable, with significant inaccuracy (over and under-reporting). Future CPRD suicide studies should use linked ONS mortality data. The under-reporting of self-harm appears to be less marked.

Language: en