Associations between primary care recorded cannabis use and mental ill health in the UK: a population-based retrospective cohort study using UK primary care data

Abstract Background Cannabis use is a global public health issue associated with increased risks of developing mental health disorders, especially in young people. We aimed to investigate the relationships between cannabis exposure and risks of receiving mental illness diagnoses or treatment as outcomes. Methods A population based, retrospective, open cohort study using patients recorded in ‘IQVIA medical research data’, a UK primary care database. Read codes were used to confirm patients with recorded exposure to cannabis use who were matched up to two unexposed patients. We examined the risk of developing three categories of mental ill health: depression, anxiety or serious mental illness (SMI). Results At study entry, the exposed cohort had an increased likelihood of having experienced mental ill health [odds ratio (OR) 4.13; 95% confidence interval (CI) 3.99–4.27] and mental ill health-related prescription (OR 2.95; 95% CI 2.86–3.05) compared to the unexposed group. During the study period we found that exposure to cannabis was associated with an increased risk of developing any mental disorder [adjusted hazard ratio (aHR) 2.73; 95% CI 2.59–2.88], also noted when examining by subtype of disorder: anxiety (aHR 2.46; 95% CI 2.29–2.64), depression (aHR 2.34; 95% CI 2.20–2.49) and SMI (aHR 6.41; 95% CI 5.42–7.57). These results remained robust in sensitivity analyses. Conclusion These findings point to the potential need for a public health approach to the management of people misusing cannabis. However, there is a gross under-recording of cannabis use in GP records, as seen by the prevalence of recorded cannabis exposure substantially lower than self-reported survey records.

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Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

Public Health Nutrition ◽

10.1017/s1368980021001592 ◽

2021 ◽

pp. 1-25

Author(s):

Qionggui Zhou ◽

Xuejiao Liu ◽

Yang Zhao ◽

Pei Qin ◽

Yongcheng Ren ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Normal Weight ◽

Sensitivity Analyses ◽

Hypertension Status ◽

Moderation Effect ◽

Increased Risk ◽

All Cause Mortality ◽

Chinese Cohort ◽

The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

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Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study

Gut ◽

10.1136/gutjnl-2018-317610 ◽

2019 ◽

Vol 68 (9) ◽

pp. 1597-1605 ◽

Cited By ~ 5

Author(s):

Simone N Vigod ◽

Paul Kurdyak ◽

Hilary K Brown ◽

Geoffrey C Nguyen ◽

Laura E Targownik ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Mental Illness ◽

Cohort Study ◽

Bowel Disease ◽

Post Partum ◽

Population Based ◽

Incidence Rates ◽

Increased Risk ◽

Inflammatory Bowel ◽

New Onset

ObjectivePatients with inflammatory bowel disease (IBD) have an elevated risk of mental illness. We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and post partum.DesignThis cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.ResultsAbout 22.7% of women with IBD had new-onset mental illness versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care and infant mortality.ConclusionWomen with IBD were at an increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.

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Mortality in Eosinophilic Esophagitis – a nationwide, population-based matched cohort study from 2005 to 2017

Upsala Journal of Medical Sciences ◽

10.48101/ujms.v126.7688 ◽

2021 ◽

Vol 126 (1) ◽

Author(s):

Lovisa Röjler ◽

John J. Garber ◽

Bjorn Roelstraete ◽

Marjorie M. Walker ◽

Jonas F. Ludvigsson

Keyword(s):

Cohort Study ◽

General Population ◽

Eosinophilic Esophagitis ◽

Population Based ◽

Sensitivity Analyses ◽

Matched Cohort ◽

Matched Cohort Study ◽

Risk Of Death ◽

Gastrointestinal Pathology ◽

Increased Risk

Background: There is a lack of knowledge about mortality in eosinophilic esophagitis (EoE). Therefore, this study aimed to examine the mortality in EoE. Methods: A nationwide, population-based matched cohort study was conducted of all EoE patients in Sweden diagnosed between July 2005 and December 2017. Individuals with EoE (n = 1,625) were identified through prospectively recorded histopathology codes from all gastrointestinal pathology reports in Sweden, representing 28 pathology departments (the ESPRESSO study). Each individual with EoE was then matched with up to five reference individuals from the general population (n = 8,003) for age, sex, year of birth, and place of residence. We used the Cox proportional hazard modeling to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) while adjusting for other potential confounders. In sensitivity analyses, mortality in EoE patients was compared with mortality in their siblings. Results: Through December 2017, 34 deaths were confirmed in EoE patients (4.60 per 1,000 person-years) compared with 165 in reference individuals (4.57 per 1,000 person-years). This rate corresponds to an aHR of 0.97 (95% CI = 0.67–1.40). HRs were similar in males (aHR = 1.00 [0.66–1.51]) and females (aHR = 0.92 [0.38–2.18]). We observed no increased risk in mortality due to esophageal or other gastrointestinal cancers in patients with EoE (aHR = 1.02 [0.51–2.02]). Mortality was similar in EoE patients and their siblings (aHR = 0.91 [0.44–1.85]). Conclusion: In this nationwide, population-based matched cohort study in Sweden, there was no increased risk of death in patients with EoE compared with their siblings and the general population.

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Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study

The Lancet Public Health ◽

10.1016/s2468-2667(20)30288-7 ◽

2021 ◽

Vol 6 (2) ◽

pp. e124-e135

Author(s):

Matthew J Carr ◽

Sarah Steeg ◽

Roger T Webb ◽

Nav Kapur ◽

Carolyn A Chew-Graham ◽

...

Keyword(s):

Primary Care ◽

Mental Illness ◽

Cohort Study ◽

Population Based ◽

Self Harm ◽

The Uk

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Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042518 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042518

Author(s):

Sílvia C Mendonça ◽

Catherine L Saunders ◽

Jenny Lund ◽

Jonathan Mant ◽

Duncan Edwards

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Cohort Study ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Secondary Outcome ◽

Policy Initiatives ◽

Increased Risk ◽

Quality And Outcomes

ObjectivesAtrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018.DesignLongitudinal cohort study.SettingEnglish primary care electronic health records linked to Index of Multiple Deprivation data.ParticipantsCohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018.Primary and secondary outcome measuresIncident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation.ResultsIncidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation.ConclusionsChanges in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018.

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Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study

Acta Endocrinologica ◽

10.1530/eje-20-1163 ◽

2021 ◽

Vol 184 (5) ◽

pp. 637-645 ◽

Cited By ~ 2

Author(s):

Anuradhaa Subramanian ◽

Astha Anand ◽

Nicola J Adderley ◽

Kelvin Okoth ◽

Konstantinos A Toulis ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Cohort Study ◽

Polycystic Ovary ◽

Population Based ◽

Glucose Regulation ◽

Impaired Glucose Regulation ◽

Ovary Syndrome ◽

Explanatory Variables ◽

Increased Risk

Objective Several recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection. Design Population-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN). Methods The main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS. Results We identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27–1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14–1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05–1.56), P = 0.015). Conclusion Women with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic. Significance statement Women with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.

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Addressing suicide risk in partners and relatives bereaved by suicide

The British Journal of Psychiatry ◽

10.1192/bjp.2017.46 ◽

2018 ◽

Vol 212 (4) ◽

pp. 197-198 ◽

Cited By ~ 5

Author(s):

Alexandra Pitman

Keyword(s):

Public Health ◽

Mental Illness ◽

Suicide Risk ◽

Population Based ◽

Prevention Strategies ◽

The Public ◽

Increased Risk ◽

Specific Support ◽

Suicide Bereavement ◽

Made In

SummaryAnalyses of population-based registers provide evidence to support an increased risk of suicide and mental illness after the suicide of a relative or partner. This editorial explores the implications of this work for progressing recommendations made in suicide prevention strategies regarding the specific support provided to people bereaved by suicide.Declaration of interestA.P. served on the Public Health England expert reference committee contributing to local guidance on commissioning and delivering postvention support (Public Health England, 2016. Support After a Suicide: A Guide to Providing Local Services) and has submitted applications for funding to investigate mediators of suicide risk after suicide bereavement. Since writing this article she has become a Patron of the Support After Suicide Partnership.

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Non-Typhoidal Salmonella and the Risk of Kawasaki Disease: A Nationwide Population-Based Cohort Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.701409 ◽

2021 ◽

Vol 12 ◽

Author(s):

Thomas Yen-Ting Chen ◽

Mei-Chia Chou ◽

Jung-Nien Lai ◽

Li-Ting Chiu ◽

Renin Chang ◽

...

Keyword(s):

Cohort Study ◽

Kawasaki Disease ◽

Comparison Group ◽

Allergic Diseases ◽

Population Based ◽

Sensitivity Analyses ◽

Research Database ◽

Data Set ◽

Increased Risk ◽

Cox Proportional Hazard Regression

ObjectiveThe aim of this study was to investigate the relationship between non-typhoidal Salmonella (NTS) infection and the risk of Kawasaki disease (KD) by using a nationwide population-based data set in Taiwan.MethodsIn this retrospective cohort study, we enrolled 69,116 patients under 18 years of age, with NTS from January 1st, 2000, to December 31st, 2013, using the population-based National Health Insurance Research Database of Taiwan. A comparison group without NTS was matched (at a 1:4 ratio) by propensity score. The two cohorts were followed from the initial diagnosis of NTS until the date of KD development or December 31st, 2013. Cox proportional hazard regression analysis was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for covariates. Also, we conducted sensitivity analyses to examine our findings.ResultsAfter adjusting for covariates, the risk of KD for the children with NTS was significantly higher than that of the comparison group (hazard ratio = 1.31; 95% confidence interval = 1.03-1.66; p < 0.01). Stratified analysis showed that the associated risk of the investigated outcome was significant in children aged ≤2 years (aHR= 1.31, 95% C.I. 1.02-1.69), in female patients (aHR= 1.46, 95% C.I. 1.03-2.08), and in those without allergic diseases.ConclusionsNTS is associated with an increased risk of KD in Taiwanese children.

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Assessment of longitudinal and cross-sectional effects of age on adult obesity in an Iranian population: results of a large population-based cohort study

10.32592/ircmj.2021.23.6.736 ◽

2021 ◽

Keyword(s):

Public Health ◽

Cohort Study ◽

Large Population ◽

Target Population ◽

Population Based ◽

Repeated Measurements ◽

Public Health Issue ◽

Cross Sectional ◽

Longitudinal Effects ◽

The Cross

Background: The risk of obesity commonly changes with age, which is a longitudinal (aging) effect. Moreover, the individuals who enter the study at the same age have similar living conditions that may influence their obesity risk in a particular way; this is a cross-sectional effect. Both cross-sectional and longitudinal effects of age should be considered for a better understanding of the effect of age on obesity and the related factors. Objectives: The present study aimed to (i) assess both the cross-sectional and longitudinal effects of age on obesity and (ii) determine how obesity changes with age in the target population using a Marginal Logistic Regression (MLR) model. Materials and Methods: The current study made use of the information of individuals who had participated in the Isfahan Cohort Study. Participants were a large group of Iranian adults over 35 years of age who lived in the central region of Iran in 2001. Repeated measurements were obtained in 2001, 2007, and 2013. Results: From 2001 to 2013, the percentage of obesity in men and women raised from 13% and 31% to 18% and 44%, respectively. Both cross-sectional and longitudinal effects of age were significantly associated with the odds ratio of obesity. There was a rise in the probability of obesity for individuals aged 35-60 years at baseline and a decline for the older ones. The odds of obesity had about a 2% increase (on average) per year, regardless of the baseline age. Conclusion: The obtained results pointed to a difference between the cross-sectional and longitudinal effects of age on the probability of obesity in the target population. The high and rising prevalence of obesity was a serious public health issue among participants, especially women, aged 35-60 years. The assessment of changes in obesity in a population-based study provides opportunities to target subpopulations that need more care and attention in public health interventions

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