Abstract
BackgroundThe prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, particularly as self-harm is a risk factor for suicide. This study aims to examine the risk of self-harm in people with vertebral fractures.MethodsRetrospective cohort study. Patients with vertebral fracture were identified within the Clinical Practice Research Datalink and matched to patients without fracture by sex and age. Incident self-harm was defined by primary care record codes following vertebral fracture. Overall incidence rates (per 10,000 person-years (PY)) were reported. Cox regression analysis determined risk (hazard ratios (HR), 95 % confidence interval (CI)) of self-harm compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by median age and sex.ResultsThe number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1 %), median age was 76.3 years. Overall incidence of self-harm in the cohort with vertebral fracture was 12.2 (10.1, 14.8) /10,000 PY. There was an initial crude association between vertebral fracture and self-harm, which remained after adjustment (HR 2.4 (95 %CI 1.5, 3.6). Greatest risk of self-harm was found in those with vertebral fractures who were aged below 76.3 years (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)).ConclusionsPrimary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Male patients aged below 76 years of age appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.
Highlights
The prevention of self-harm is an international public health priority
Crude hazard ratios (HR) were reported with 95 % confidence intervals (CIs) to examine the association between the presence of vertebral fracture and subsequent incidence of self-harm compared to the matched unexposed cohort
After stratifying at the median age, we found there to be a marked difference between the crude risk of self-harm across the < 76.3 and ≥ 76.3 years strata for the vertebral fractures cohort (HR 3.1 (95 %CI 1.9, 4.8) and HR 1.7 (95 %CI 1.0, 2.7) respectively)
Summary
The prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, as self-harm is a risk factor for suicide. Vertebral fractures may result in physical impairments, such as kyphosis and height loss, and have been linked with psychological sequelae including anxiety [11] and depression [12] As many as 20 % of the elderly population are affected by vertebral fractures This fracture type has a well-documented association with reduced quality of life and increased disability [13, 14], both of which have been reported as motivators for selfharm in older adult [15]. We hypothesise that the burden presented by such risk factors, either individually or synergistically, in patients with vertebral fracture would increase the risk of subsequent self-harm
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