The latest figures from Public Health England (PHE) show hospital admissions for liver disease continue to rise, with a total of 20,202 admissions for alcoholic liver disease in 2016/17. See PHE Liver Disease Profiles here.
PHE state since 2013/14 the admission rate for alcoholic liver disease has been significantly increasing every year, making up close to one third of the total 68,364 liver disease admissions in England. Liver disease is 'almost entirely preventable' according to PHE, with the major risk factors of alcohol, obesity and hepatitis B and C accounting for up to 90% of cases.
Continuing rises in alcohol-related liver disease raise interesting questions given falls in alcohol consumption since 2004 and apparent stabilising of alcohol-related hospital admissions overall (though the broad and narrow measures paint somewhat different pictures). Most simply this may be partially explained by separating out consumption changes by drinking levels, notably whereby risky or 'hazardous' drinking has declined whilst harmful and dependent drinking has not. Indeed overall falls in consumption have been driven by the well-publicised significant declines in youth drinking, whereas middle to older aged adult's drinking has remained stable or even increased.
As such, drinking levels do not appear to have declined in cohorts of the population more at risk of longer term health consequences, notably older and heavier drinking groups. Meanwhile acute problems like alcohol-related violent crime have seen declines consistent with falling consumption amongst young people. However, rising obesity has also contributed significantly to climbing liver disease rates, and indeed combining multiple risk factors such as poor diet and risky drinking exponentially increases liver disease mortality risk. As such liver disease rates are significantly higher in areas of deprivation with people in Blackpool nearly eight times as likely to die from liver disease as those in Norfolk.
Action on liver disease?
The Lancet Commission on Liver Disease has repeatedly called for further action to address what it describes as the UK liver disease "crisis", claiming liver disease mortality rates have increased 400% since 1970. Last year it produced a report on the 'Financial case for action on liver disease' which predicted 63,000 alcohol-related deaths over the next five years. It followed a 2016 Lancet report highlighting regional and national level action that should be taken to improve early identification, treatment and also population levers such as minimum pricing.
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.
Judi Rhys, CEO of the British Liver Trust said:
“Liver disease is a silent killer because there are often no obvious symptoms in the early stages. We know that at the moment three quarters of people are diagnosed in a hospital setting when the condition is quite advanced. GPs need to understand how to interpret the results of blood tests and clear pathways need to be commissioned so that they know who to refer and how to refer.
“There has also been an exponential increase in the supply of low price alcohol to the public with a growing range of cheap drink promotions in shops. More people drink at home and more people drink wine and spirits which have a much higher alcohol content. A common myth is that you have to be an alcoholic to damage your liver. The term alcoholic is misleading as alcohol dependency is a spectrum and more than one in five people in the UK currently drink alcohol in way that could harm their liver.”
With a new national alcohol strategy for England expected next year, many will hope for more direct action to improve treatment and early intervention, and perhaps more crucially, to stem the continued rise of alcohol-related liver disease through tighter population level controls.
See here for SHAAP guidance on liver disease which aims to ensure consistency in approaches to prevention, treatment, care, support and recovery.
Comments