By Dr Ananya Mandal, MD
Too much alcohol is associated with 25% increase in deaths from liver disease in England in under a decade, according to the government's specialist NHS unit on terminal care.
The first report from the fledgling National End of Life Care Intelligence Network warns that the victims of liver disease are getting younger, with deaths increasing among people in their forties. Deaths rose from 9,231 in 2001 to 11,575 in 2009; some 60% of these were men, and 90% of them were under 70. Deaths are more common in England's northern regions marked by high unemployment and low educational achievement.
The report was revealed by Martin Lombard, the NHS's national clinical director for liver disease. He said, “The key drivers for increasing numbers of deaths from liver disease are all preventable –alcohol, obesity, hepatitis C and hepatitis B… We must focus our efforts and tackle this problem sooner rather than later.”
Liver disease (also called hepatic disease) is a broad term to describe several disorders that affect the liver. The report categorizes these into Alcoholic, fatty and other chronic liver diseases. Alcoholic liver disease is 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 is that 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. Other conditions include liver cancer, viral liver disease and pancreatitis (inflammation of the pancreas, most commonly caused by alcohol, which can lead to jaundice and abnormal liver function.)
The figures for causes of death between 2001 and 2009 show a general decline in other major causes, such as heart disease, but the report acknowledged that cancer and vascular and respiratory conditions were still the big killers.
However, more than one in 10 deaths among people in their forties followed a liver condition, and its place in the medical league table of “years of life lost” is high. 37% of liver disease deaths for people in their forties were alcohol related, split 41% for men and 30% for women. Alcohol was a much greater factor for deaths in deprived areas, judged by the national ward index of social deprivation: 44% of deaths were from liver disease in areas at the bottom of the table, 28% in those at the top.
Terminal liver disease is very demanding of NHS resources, with two-thirds of those affected dying in hospital, compared with an average of 55% for other conditions. The report, Deaths from Liver Disease – Implications for End of Life Care in England, showed that the north-west region had the highest liver disease death rate – 24 per 100,000, with 11.4 from alcohol complications. It was followed by the north-east with 21.9 and 10.1. The east of England had the lowest rate, 12.9 and 4.9, followed by the south-west, 14.3 and 6.4, and the south-east,14.8 and 5.8.