New liver disease profiles have been released by Public Health England (PHE) detailing the local and regional impact of liver disease. PHE highlight liver disease is the only major cause of mortality increasing in England, despite it decreasing in Europe. Liver deaths in England increased 40% between 2001 and 2012.
Alcohol specifically accounts for 37% of all liver disease deaths, although over 90% are due to one of the three main risk factors: alcohol, viral hepatitis and obesity. One in ten people who die in their forties die of liver disease, whilst 90% of people who die from liver disease are under 70 years old.
The profiles however highlight stark disparities across England, largely reflecting health inequalities. Blackpool has the highest death rate among men with 58.4 deaths per 100,000 as the North West and North East top the regions, as shown by a recently published regional map of alcohol-related liver disease.
- Over a decade the number of people dying with an underlying cause of liver disease in England rose by 40% from 7,841 to 10,948
- Most liver disease deaths are from cirrhosis (a hardening and scarring of the liver) or its complications – people die from liver disease at a young age with 90% under 70 years old and more than 1 in 10 in their 40s
- Liver disease is the third biggest cause of premature mortality and lost working life behind ischaemic heart disease and self-harm
- Most liver disease is preventable – only about 5% of deaths are attributable to autoimmune and genetic disorders
- It’s a disease of inequalities. People who live in the most deprived fifth of areas in England are more likely to die from liver disease than those who die in the most affluent fifth.
- Liver disease, and death from it, is associated with stigma mainly because of the risk factors. This sometimes makes it hard for the patients to access care and hard for the families especially in bereavement
- 70% of patients with liver disease die in hospital...
A 'national liver strategy'?
Earlier this year a report from the all-party parliamentary hepatology group said the Government's failure to tackle rising liver disease was a scandal resulting in a "shameful waste of lives". The group called for minimum pricing and action to ensure better care coordination and early identification. In 2013 a review of patients who died with alcohol-related liver disease by a patient care and death review group also called for improvements in alcohol brief intervention (IBA), access to treatment, alcohol care teams and improved hospital pathways.
In 2009 the Department of Health said it would deliver a National Liver Strategy to combat the rise of liver disease. By 2012, more reports indicated it was soon coming, but never appeared. Of course a liver strategy would need to reflect a number of areas being led on by PHE, and recognise health inequalities - something set out in the Public Health Outcomes Framework. Health groups though will continue to argue real longer term outcomes will also depend on action on price, availability and marketing of alcohol and junk food.
The challenge will be significant. Liver disease develops silently and obvious signs and symptoms may only appear when changes are irreversible, therefore the identification of people with risk factors for liver disease in primary care is a critical first step in the pathway.