UK Liver Disease Burden: The Crisis We Can’t Afford
A new report published today in the Lancet warns that the UK liver disease burden is continuing to rise, blighting the poorest groups and lowering economic productivity. Experts argue insufficient measures are being taken to control the main lifestyle risk factors driving this burden of largely preventable disease, namely alcohol consumption, obesity and viral hepatitis.
The findings are presented in the fourth report of the Lancet Standing Commission on Liver Disease in the UK. Figures show that death rates from liver disease are higher amongst middle-aged and lower income groups and the report indicates that liver disease is set to overtake ischaemic heart disease as the leading cause of premature mortality in the next two years.
Commenting on the report, Professor Roger Williams, CBE, Chairman of the Commission, said:
“For too long the diagnosis and care of patients with liver disease has been hampered by the stigma associated with the illness but the reality now is that this is not a disease of the few but of wide sections of the population. Doctors, health care workers, the general public, Government – we cannot stand by and allow this disease burden to grow unchecked when we can take action now to improve the nation’s health”.
Rates of end-stage liver disease and primary liver cancer due to excess alcohol consumption are increasing year on year and with over 60% of the adult population now obese, the incidence of non-alcohol related fatty liver disease (NAFLD) is rising inexorably. According to GP records, only 1% of the population are currently recorded as having NAFLD but the true figure is likely to be nearer 30%. These rates of disease are not only a burden on society but a huge cost to an already overstretched NHS. Unless trends are reversed, it is estimated that the consequences of alcohol misuse will cost the NHS £17billion over the next 5 years and failure to take action on obesity could add a further £1.9-2billion a year.
Regulatory measures, particularly taxation, do have a real and measurable impact and the Lancet Commission welcomes the favourable decision of the UK Supreme Court which means that in 2018 Scotland will be the first of the UK nations to introduce Minimum Unit Pricing for alcohol. Modelling evidence shows that within 5 years of the introduction of MUP in England, there would be 1,150 fewer alcohol-related deaths and savings in healthcare costs of £325million. Government has laid the foundations to tackle childhood obesity with the Childhood Obesity Plan but it must be supported by strong and decisive policies to tackle the obesogenic environment such as an extension of the sugar tax to food products, particularly those consumed by children. These regulatory measures would target those at most risk from serious disease, adults and children, and improve their chances of good quality life.
Liver disease is a notoriously silent killer. Three quarter of cases are only diagnosed at a late stage when treatment options are limited. The UK needs urgently to improve the early detection of liver disease and the Commission highlights the most useful blood tests for use in primary care. It also strongly recommends the introduction of transient elastography in the community setting. This is a quick, non-invasive test (commonly undertaken with a scanner such as a Fibroscan) which can identify those at most risk of developing more serious disease. Services for paediatric liver disease continue to be a gold standard but transition arrangements to adult services for the increasing numbers of children surviving childhood illness need to be improved, as do services for adult patients, with continuing problems of access to specialist care in some parts of the country.
Judi Rhys, Chief Executive of the British Liver Trust, said:
“This report suggests that over 18 million people in the UK could potentially have non-alcohol related fatty liver disease but only around 600,000 of these are currently recorded on GP records. In addition, many of us are putting our livers at risk from drinking too much alcohol. The shocking numbers highlighted show that we are facing a liver disease crisis. There is an enormous cost benefit to addressing liver disease early and we should make sure that primary care practitioners have all of the tools and levers they need to enable early diagnosis and prevention.”
The Lancet Commission into Liver Disease in the UK is supported by key health care organisations and charities and they are speaking with a united voice: it is possible to achieve change in the nation’s health and the time to do that is now.
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