Ageing Well - Health
Liver Disease
Introduction
Liver disease is caused by a wide range of issues, both congenital diseases, such as hereditary metabolic and autoimmune conditions, and lifestyle choices. Lifestyle choices such as obesity and alcohol use, alongside undiagnosed hepatitis infections are responsible for around 95% of liver disease cases in England. Alcohol is the single biggest contributor to liver disease, with roughly one third of cases being alcohol related.
Earlier healthcare diagnosis of liver conditions is the most significant means of reducing the burden of liver disease. However awareness raising campaigns related to alcohol consumption and obesity are also vitally important.
Chronic liver disease can also lead to cirrhosis of the liver, which is where the liver is damaged by a scaring. Cirrhosis of the liver has serious health consequences including portal hypertension (increased pressure in a vein which supplies the liver with blood), which can lead to dangerous fluid buildup around the body.
Liver disease is increasing in prevalence, which is in contrast to other chronic disease such as stroke and heart disease.
Liver disease
Under 75 mortality rates for liver disease in Hartlepool are some of the highest in England. The town’s overall mortality rate of 32.0 per 100,000 people is the 5th highest mortality rate in England.
This is mirrored in the mortality rates for males and females, which are the 6th and 10th highest rates in England respectively. However these rates have seen a decline in the 2015/17 figures.
Hartlepool had seen an 84% increase in its under 75 mortality rate for liver diseases from 20.3 per 100,000 in 2011/13 up to 37.3 per 100,000 in 2014/16. This three year increase has been halted in 20152/17, with the mortality rate falling by 14% to 32.0 per 100,000.
Hartlepool’s mortality rate is still significantly worse than the England average and the highest in the north east region by nearly 4 deaths per 100,000 people. For males the mortality rate for 2015/17 is above 40 per 100,000 people, this is down from nearly 50 per 100,000 in 2014/16, and in both cases Hartlepool was the highest rate in the north east.
While Hartlepool’s mortality rates for liver diseases are amongst the highest in England, for hospital admissions for liver diseases Hartlepool sits in a position statistically similar to the England average.
Whilst the admission rate is increasing, Hartlepool has the 3rd lowest hospital admission rate due to liver disease in the north east.
Hartlepool’s increase in the last three reporting periods has largely been driven by the increase in hospital admissions due to liver disease for males, rather than females. Male admissions increased by 93% in 2014/15, from 108.4 to 209.7 per 100,000 people. This has since stabilised, with movement of no more than 8% in the subsequent years.
The pattern of high mortality levels, but relatively low hospital admissions is also present in alcoholic liver disease.
The under 75 mortality rate from alcoholic liver disease follows a very similar trend to that of the under 75 mortality rate from liver disease, which is largely to be expected as alcoholic liver disease accounts for 59% of deaths due to liver disease. The mortality rate for alcoholic liver disease has had the same rapid increase from 2011/13 and has seen a decrease in the most recent figures.
Hartlepool’s under 75 mortality rate for alcoholic liver disease is the 3rd highest in England, which is higher than the 5th place rank for liver disease in general.
Hospital admission rates for alcoholic liver disease, while not mirroring the pattern of the admission rate of liver disease in general, is also at a level statistically similar to the England average.
Hospital admission rates for alcoholic liver disease have not had the spike that the admission rate for liver disease did, but has gradually increased over the last four reporting periods.
Similarly for non-alcoholic fatty liver disease Hartlepool’s mortality rate is the 5th highest in England, but the hospital admission rate is comparable to the England average.
Current Services
The only UK cause of premature death that is increasing in those of working age is liver disease. It is believed liver disease can ultimately be avoided and is caused by poor lifestyle choices.
This is mainly due to lifestyle factors such as obesity and type 2 diabetes mellitus causing non-alcoholic fatty liver disease; alcohol related liver damage and to a lesser degree viral hepatitis. North Cumbria and the North East have higher than average rates of obesity, type 2 diabetes mellitus, and higher alcohol consumption. Not surprisingly this is reflected in higher than expected admissions to hospital due to alcohol and deaths from liver disease.
The early stages of liver disease do not show any symptoms, which means the liver is already scarred by the time complications present themselves. Unfortunately around 80 per cent of liver disease patients first visit hospital when little or nothing can be done to reverse the problem.
GPs have been briefed by our liver disease specialists from secondary care on how to recognise signs of liver disease. The CCG have jointly developed a piece of work with North Tees Hospitals Foundation Trust to encourage GP practices to review their practice level data to help identify more patients who are currently undiagnosed with Liver Disease.
Future Intentions
The NHS Long Term plan highlights that alcohol contributes to conditions including cardiovascular disease, cancer and liver disease, harm from accidents, violence and self-harm, and puts substantial pressure on the NHS. Hospitals in Bolton, Salford, Nottingham, Liverpool, London and Portsmouth have improved the quality of alcohol-related care, by establishing specialist Alcohol Care Teams (ACTs). ACTs significantly reduced accident and emergency (A&E) attendances, bed days, readmissions and ambulance call-outs. Over the next five years, those hospitals with the highest rate of alcohol dependence-related admissions will be supported to fully establish ACTs using funding from their clinical commissioning groups (CCGs) health inequalities funding supplement, working in partnership with local authority commissioners of drug and alcohol services. Over the coming year the CCG will jointly develop plans with the local authority to drive this forward.
