Liver Disease Profiles

The liver disease profile provides an invaluable resource relating to one of the main causes of premature mortality nationally. Liver disease mortality rates are increasing in England, while decreasing in most EU countries.

The liver disease profile is responsibility of the Office for Health Improvement and Disparities (OHID). It contains information for:

  • England
  • former government office regions
  • upper tier local authorities
  • lower tier local authorities, if available
  • integrated care boards, if available

The local authority profile will support the development of Joint Strategic Needs Assessments and work of Health and Wellbeing Boards.

This profile shows:

  • local key statistics
  • questions to ask locally about actions to prevent liver disease

For exact dates of updates to the profile, visit GOV.UK statistical release calendar.

 

Revisions to mid-2022 population estimates

The Office for National Statistics (ONS) released revised 2022 mid-year population estimates to account for updated estimates of international migration for England and Wales. Due to the revision 2022 mortality data for all geographies (excluding ICBs and NHS regions) have been revised to use the updated mid-2022 population estimates.

The resultant revisions to rates are very small and do not introduce any meaningful changes to results previously presented.

Mid-2022 populations for small geographical areas (which are used to calculate data at ICB and NHS region level) will be revised at a later date, and population revisions will be accounted for in future updates to the Profile.

 

The impact of liver disease

Deaths from liver disease are increasing in England while in most EU countries liver disease deaths are falling. 

In 2020 the number of people who died with an underlying cause of liver disease in England rose to 10,127 from 9,218 in 2019. In 2021, there were 10,521 cases. This ongoing rise contrasts with other major causes of disease which have been declining.

Liver disease is largely preventable. While approximately 5% of liver disease is attributable to autoimmune disorders (diseases characterised by abnormal functioning of the immune system), most liver disease is due to three factors:

  • alcohol
  • obesity
  • viral hepatitis

For more information, read this blog on preventable liver disease.

 

Alcohol-related liver disease

Alcohol consumption is the most common cause of liver disease in England. The more alcohol someone drinks, the higher their risk of developing liver disease.

Alcohol-related liver disease accounts for over a third of liver disease deaths.

The local alcohol profiles for England offers further data measuring the impact of alcohol on local communities.

 

Hepatitis B

Hepatitis B virus is transmitted through contact with infected blood or other body fluids. During the acute phase of infection, most people are asymptomatic. Only a third of adults and a smaller proportion of children develop symptoms which may include fever and jaundice.

Hepatitis B infection can lead to chronic disease. Most acute symptomatic infections are transmitted through behaviours such as injecting drug use and sexual contact.

The risk of developing chronic hepatitis B infection depends on the age at which infection is acquired. Chronic infection occurs in up to 90% of children who acquire the infection under the age of 5 years but less than 10% of people infected as adults. Immunisation starting at birth is highly effective at preventing infection in infants born to hepatitis B positive mothers who are at high risk of developing chronic infection.

Chronic infection can lead to chronic liver disease and liver cancer. The majority (95%) of newly identified chronic hepatitis B infections are acquired overseas at birth or at a young age. Hepatitis B vaccines are available and highly effective. Immunisation is recommended for high-risk groups.

 

Hepatitis C

Hepatitis C virus is mainly transmitted through contact with infected blood.

Injecting drug use is the most important risk factor for infection within the UK. Other main risks are:

  • being born or brought up in a country with high prevalence of chronic hepatitis C (especially those in Africa and Asia, including Egypt, China and Pakistan)
  • having received blood transfusions in the UK prior to the introduction of HCV screening of blood in 1991

Hepatitis C is often asymptomatic, and symptoms may not appear until the liver is severely damaged. Around 20-30% of infected people clear their infection naturally within the first six months of infection.

For the infected people who didn’t clear the infection, hepatitis C is a chronic infection which can lead to liver disease and liver cancer. Data from the Unlinked Anonymous Monitoring survey of people who inject psychoactive drugs suggest that levels of infection in this group are high at around 50%. Around one in 20 of those who inject image and performance enhancing drugs (such as anabolic steroids and melanotan) are infected with hepatitis C.

The prevalence of chronic hepatitis C infection in England is estimated to be 0.4% of adults (approximately 160,000 people).

 

Non-alcoholic fatty liver disease

Non-Alcoholic Fatty Liver Disease (NAFLD) is the accumulation of fat within the liver that is not caused by alcohol consumption. It’s usually seen in people who are overweight or obese.

Although the great majority of people with NAFLD never experience any symptoms from the condition, a minority may progress to a more serious form of the disease known as non-alcoholic steatohepatitis, which may ultimately lead to fibrosis and, in a small number of cases, cirrhosis and/or liver cancer.