Fatal cases of liver disease are rising, according to media reports today. In under a decade there has been a 25% increase in deaths from the condition, with alcohol causing more than a third of total cases. In contrast, other major causes of death, such as heart disease and cancer, have been in decline in recent years.
These disturbing new figures have come from a report by the NHS National End of Life Care Programme, as one of a range of reports looking at the nature of death in England. The report also points out that the vast majority of liver deaths are in people under the age of 70, with liver disease now accounting for 10% of deaths among people in their 40s.
The report also found that more liver deaths occur among men than women and that alcohol-related liver disease deaths are more common in the most deprived areas of England than in the least deprived areas. The report also says that over two-thirds of people with liver disease end up dying in a hospital rather than at home.
What did the report look at?
The new report “Deaths from Liver Disease – implications for end of life care in England”, is reportedly the first to provide a high-level overview of deaths from liver disease in England. It looks at numbers of deaths from liver disease, the underlying causes and how the figures break down by age, sex, region and socioeconomic region.
The NHS National End of Life Care Programme has produced the report as the first in a series on end-of-life care for patients with liver disease. The report also looks at the setting where people with liver disease died, whether at home or in hospital. The primary aim is to help inform decisions on end-of-life care by policy makers, commissioners and providers, as well as to inform patients and carers.
What is liver disease?
Liver disease (also called hepatic disease) is a broad term to describe several disorders that affect the liver. The report categorises these into:
- Alcoholic liver disease: liver damage caused by alcohol misuse and which covers a range of stages and conditions (see below), including fatty liver, hepatitis and cirrhosis.
- Fatty liver disease: in which there is too much fat in the liver. It is one of the most common forms of liver disease and leads to more advanced conditions such as hepatitis or fibrosis. It can be caused by excess alcohol (leading to alcoholic fatty liver disease) but also other conditions such as diabetes (causing non-alcoholic fatty liver disease).
- Other chronic liver diseases such as cirrhosis and fibrosis: these are the result of continuous long-term liver damage. They may be the final stage of alcoholic liver disease but there are other causes, such as when a virus damages the liver. Fibrosis describes scarring of the liver, and cirrhosis describes scarring and the formation in the liver of hard irregular bumps called nodules. These conditions stop the liver from functioning properly. The damage is irreversible.
- Liver cancer: primary liver cancer (cancer that begins in the liver) is rare in England. Risk factors include alcohol misuse, the viral infections hepatitis B and C, and obesity.
- Viral liver disease: hepatitis literally means “liver inflammation”. This can have several causes, including viruses (most commonly the hepatitis viruses but there are others), alcohol or drugs (both prescription drugs and illegal). The term “viral liver disease” refers to the forms of liver inflammation following viral infection, which can range from acute hepatitis or chronic hepatitis, fibrosis and cirrhosis, and liver cancer.
- Pancreatitis: inflammation of the pancreas, most commonly caused by alcohol, which can lead to jaundice and abnormal liver function. As the report says, it can sometimes be hard to tell whether abnormal liver function is due to disease in the liver, biliary ducts or pancreas.
With the exception of the brain, the liver is reported to be the most complex organ in the body. Its functions include filtering toxins from the blood, regulating blood cholesterol levels and helping to fight infection and disease.
The liver is very resilient and is capable of regenerating itself, but only to a certain extent: certain factors such as excess alcohol misuse over several years can cause long-term, sometimes severe, damage. Often there are no symptoms in the early stages of liver disease.
How many people does it affect?
According to the British Liver Trust (BLT), liver disease is now the fifth largest cause of death in the UK, after heart disease, cancer, stroke and respiratory disease. The report says that liver disease kills more people than diabetes and road deaths combined.
However, the BLT points out that there are many more people living with liver disease and others who have a liver disease but are not aware of it. It estimates that around 2 million people have a liver problem at any one time.
What did the new report find?
Below are the key findings from the report on deaths from liver disease in England:
- Liver disease causes approximately 2% of all deaths.
- The number of people who die from liver disease in England is rising: in 2001 it killed 9,231 people, but in 2009 this rose to 11,575 deaths.
- More men than women die from liver disease (60% are men, 40% women).
- Liver disease disproportionately affects younger age groups: 90% of people who die from liver disease are under the age of 70 and more than 1 in 10 deaths of people in their 40s are from liver disease, mostly alcoholic liver disease.
- Alcoholic liver disease accounts for well over a third (37%) of liver-disease deaths.
- There are three times as many deaths from alcoholic liver disease in the most deprived areas of England compared with the least deprived.
- Overall, the North West of England, with a rate of 24 deaths per 100,000, has the highest death rate from liver disease. The East of England has the lowest, with a death rate of 12.9 per 100,000.
- People dying from liver disease often have complex end-of-life care needs and over 70% die in hospital.
The report also points out that death from liver disease is often associated with stigma, due to the fact that as well as coming from deprived socioeconomic backgrounds those dying of alcoholic liver disease may have mental health or drug dependence problems which complicate their social and family circumstances.
What do the authors say on their results?
Commenting on the report, Professor Martin Lombard, National Clinical Director for Liver Disease, said:
“This report makes for stark reading about the needs of people dying with liver disease. Over 70% end up dying in hospital and this report is timely in helping us understand the challenges in managing end-of-life care for this group of people. The key drivers for increasing numbers of deaths from liver disease are all preventable, such as alcohol, obesity, hepatitis C and hepatitis B. We must focus our efforts and tackle this problem sooner rather than later."
What are the signs of liver disease?
Most types of liver disease do not usually cause any symptoms until the liver has been extensively damaged. Signs and symptoms, if present at all, may be non-specific, and liver disease is often diagnosed during the course of testing for other conditions. In the case of alcoholic liver disease, later symptoms can include:
- weight loss
- loss of appetite
- pain or soreness around the liver
- yellowing of the eyes and skin (jaundice)
- swelling in the ankles and abdomen
- confusion or drowsiness
See our section on alcoholic liver disease for more symptoms.
How much should I be drinking?
The recommended daily limits for alcohol consumption are:
- no more than three-to-four units of alcohol a day for men
- no more than two-to-three units of alcohol a day for women
A unit of alcohol is equivalent to 10ml of pure alcohol, which is roughly half a pint of normal strength lager, a small glass of wine or a single measure (25ml) of spirits. For both men and women, including some alcohol-free days each week is also recommended. You are putting your health at risk if you regularly exceed the recommended daily limits. Women who regularly drink more than six units of alcohol a day (or more than 35 units a week) and men who regularly drink more than eight units a day (or 50 units a week) are at the highest risk of alcohol-related harm.