New liver disease atlas points to significant variation across England

Posted on: 14th September 2017

The rate of people dying early from liver disease in some parts of England is almost 8 times higher than others, according to new data published by Public Health England (PHE) today.

Responding to the launch of the Atlas of Variation of liver disease, Vanessa Hebditch, Director of Communications and Policy at 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 in some areas now being mid-fifties. 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. This means that primary care needs to have a much greater emphasis on liver disease.”

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. The atlas will help health professionals to allocate their resources to improve patient outcomes.

The Atlas shows premature mortality rates – dying before the age of 75 – ranged from 3.9 per 100,000 in South Norfolk CCG to 30.1 per 100,000 in Blackpool CCG, a 7.7-fold difference.

The Atlas paints a mixed picture, with 10 indicators showing improvements including; a reduction of premature deaths and fewer hospital alcohol specific admissions for under 18s.

Nine of the indicators have become worse over time, including a doubling of hospital admission rates for cirrhosis from 54.8 per 100,000 to 108.4 per 100,000 people over the past decade. This indicator also varies significantly across the country with an 8.5 fold variation across CCGs and this gap has widened over the past decade. 

Liver disease is responsible for almost 12% of deaths in men aged 40 to 49 years and is now the 4th most common cause of Years of Life Lost in people aged under 75 after heart disease and lung cancer.

Professor Julia Verne, head of clinical epidemiology at Public Health England said:

“Chronic liver disease is a silent killer of young adults, creeping up and showing itself when it’s often too late. However, around 90% of liver disease is preventable.

“We hope local health professionals will make the most of this rich data source to inform how they reduce the burden of liver disease in their areas.”

The Atlas also lays bare the impact of the stark health inequalities in England. Inequality plays a role in the significant variation in risk factors of liver disease – excessive alcohol consumption, obesity, and hepatitis B and C.

For example, there is a 7.4-fold difference in the rate of alcohol-specific hospital admissions across the country, with the majority of the higher rates being clustered in the more deprived areas. Also, in the most deprived fifth of the country, people with liver disease die 9 years earlier than those in the most affluent fifth.

These data will underline the importance of developing a strategy to tackle the rising burden of liver disease, especially in younger adults and even children. Liver disease can take 20 years to show up as symptoms.

The Atlas is made up of 39 indicators, 19 of which show trend data over time. It shows the degree of variation across the country, a national figure for comparison and commentary providing options for action and a list of evidence based resources for local health systems to improve.

Visit PHE website to view the Atlas here