Liver disease & health inequalities: new data, old approach?

Public Health England (PHE) have announced updated figures on liver disease, with various media reporting on the wide regional variation seen. However those who have been calling for further action to address the burden of liver disease may feel significant changes are yet required to affect real change.

PHE highlight liver disease is almost entirely preventable with the major risk factors, alcohol, obesity and Hepatitis B and C accounting for up to 90% of cases. Liver disease is responsible for almost 12% of deaths in men aged 40 to 49 and is now the fourth most common cause of ‘years of life lost’ in people aged under 75, after heart disease and lung cancer. 

The data however presents a 'mixed picture'; ten related indicators show improvements, including a reduction of premature deaths and fewer alcohol-specific hospital admissions for under 18s, likely to reflect declining consumption amongst younger ages. Nine indicators though have continued to worsen, including a doubling of hospital admission rates for cirrhosis over the past decade. The extent of regional variation again highlights the role of health inequalities and alcohol-related harms, with those in Blackpool nearly eight times as likely to die from liver disease as those in Norfolk.

Vanessa Hebditch of the British Liver Trust, said:

“Across the UK we are facing a liver disease crisis. People are dying of liver damage younger and younger, with the average age of death now being mid-50s. It is also becoming more and more common for liver units to have much younger individuals waiting for a liver transplant or dying on the wards.

“This data shows that not only do we need to ensure that there are excellent and consistent liver services across the country but that need to be diagnosed much earlier to obtain effective care, treatment and support as soon as possible.”

PHE say the data shows 'the importance of developing a strategy to tackle the rising burden of liver disease, especially in younger adults and even children' especially as liver disease symptoms can take 20 years to show.

Lancet Commission on Liver Disease: national versus regional action?

Earlier this year a report on the 'Financial case for action on liver disease' predicted 63,000 alcohol-related deaths over the next five years, released as the Supreme Court heard what is expected to be the final stage of Scotland's long running minimum unit pricing (MUP) battle. Last year a report, New metrics for the Lancet Standing Commission on Liver Disease in the UK, also called for further action at both regional and national level, including policies at curb overall alcohol consumption. These included:

1. Improving expertise and facilities in primary care to strengthen detection of early disease and its treatment, and screening of high-risk patients in the community
2. Establishment of acute liver services in district general hospitals linked with 30 regional specialist centres for complex investigations and treatment, and increased provision of medical and nursing training in hepatology
3. A national review of liver transplantation to ensure better access for patients to increase capacity
4. Specialist paediatric services and continuity of care in transition arrangements for children with liver disease reaching adult life
5. Measures to reduce overall alcohol consumption in the country
6. Promotion of healthy lifestyles to reduce obesity and the burden of non-alcoholic fatty liver disease
7. Eradication of chronic hepatitis C virus infection from the country by 2030 and a major reduction in the burden of disease for hepatitis B
8. Increasing awareness of liver disease in the general population and within the NHS; work of liver patient support groups.

The Lancet Commission has repeatedly called for further action to address the UK liver disease "crisis", claiming liver disease mortality rates have increased 400% since 1970. The extent to which its recommendation are being addressed will be unlikely to be seen as sufficient, particularly in regard to the calls for national level policies such as MUP called for to improve overall population level health.

In 2014 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", calling for MUP 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.

Local areas may feel the data and guidance is clear, but a lack of resources and national level action is constraining the ability of local and regional activity to significantly affect change.