Public Health England

The liver disease profiles provide an invaluable resource relating to one of the main causes of premature mortality nationally; a disease whose mortality rates are increasing in England, while decreasing in most EU countries. The local authority profiles will support the development of Joint Strategic Needs Assessments and work of Health and Wellbeing Boards presenting local key statistics and highlighting questions to ask locally about current action to prevent liver disease.

The website contains data for Upper Tier Local Authorities, former Government Office regions, England and where available Lower Tier Local Authorities. The downloadable PDF profiles are produced annually for each Upper Tier Local Authority and contain key facts, prevention strategies, questions that you should ask locally and links to further resources.

How big an issue is liver disease?

Deaths from liver disease are increasing in England. This is in contrast to most EU countries where liver disease deaths are falling. In 2014 the number of people who died with an underlying cause of liver disease in England rose to 11,597. This rise is in contrast to other major causes of disease which have been declining. Liver disease is largely preventable. Whilst approximately 5% is attributable to autoimmune disorders (diseases characterised by abnormal functioning of the immune system), most liver disease is due to three main risk factors: alcohol, obesity and viral hepatitis.

Public Health England blog on preventable liver disease

Alcohol-related liver disease (ALD - ICD10 K70*)

Alcohol is the most common cause of liver disease in England. Alcohol-related liver disease accounts for over a third of liver disease deaths. The more someone drinks, the higher their risk of developing liver disease.

Hepatitis B - (ICD10 B16, B180-B181)

Hepatitis B virus is transmitted through contact with infected blood or other body fluids. Infection can lead to chronic disease and during the acute phase of infection the majority of people are asymptomatic; only a third of adults and a smaller proportion of children develop symptoms which may include, fever and jaundice. Most acute symptomatic infections are acquired through adult risk 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. Without immunisation starting at birth, infants born to hepatitis B positive mothers are therefore at high risk of acquiring 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 and immunisation is recommended for high risk groups.

Hepatitis C - (ICD10 B171, B182)

 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. People born or brought up in a country with high prevalence of chronic hepatitis C are also at risk (especially those in Africa and Asia, including Egypt, China and Pakistan), as are those who received blood transfusions in the UK prior to the introduction of HCV screening of blood in 1991. The prevalence of chronic hepatitis C infection in England is estimated to be 0.4% of adults (approximately 160,000 people).

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 remainder, 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.

Non-alcoholic fatty liver disease (NAFLD - ICD10 K760)

Obesity is an important risk factor for non-alcoholic fatty liver disease (NAFLD), a term used to describe accumulation of fat within the liver that is not caused by alcohol consumption. It is 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.

Recent updates

May 2016

Alcohol-specific hospital admissions are now available for the period 2014/15.

February 2016

Deprivation has been updated for 2014 populations. Excess weight for year 6 children and Hepatitis B vaccine uptake for 2 years olds are now available for 2014/15.

December 2015

Premature mortality indicators for hepatitis B & C related end-stage liver disease/hepatocellular carcinoma, and non alcoholic fatty liver disease (NAFLD) are now available for the period 2012-14. Earlier time periods for NAFLD mortality have been revised. All hospital admission indicators are now available for 2013/14. Drug treatment indicators are available for 2014/15. Earlier time periods for drug treatment indicators have been revised for 2012/13 and 2013/14.

November 2015

Premature mortality indicators for all liver disease and alcoholic liver disease are now available for the period 2012-14.

July 2015

Alcohol-specific hospital admissions are now available for the period 2013/14 and available for Districts.

February 2015

Premature mortality indicators for alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis B related end-stage liver disease/hepatocellular carcinoma & hepatitis C related end-stage liver disease/hepatocellular carcinoma mortality have been updated, and are now available for the period 2011-13.

Metadata for premature mortality of hepatitis B & C related end-stage liver disease/hepatocellular carcinoma have been amended to better reflect methodology.

December 2014

Premature mortality indicators for alcoholic liver disease, non-alcoholic fatty liver disease, hepatitis B related end-stage liver disease/hepatocellular carcinoma & hepatitis C related end-stage liver disease/hepatocellular carcinoma mortality have been updated, and will be available for the period 2011-13 in the coming February 2015 release, pending the quality assurance process.

November 2014

Premature mortality for all liver disease has been updated, and is now available for the period 2011-13.

Hospital admissions for alcoholic liver disease in males in Herefordshire, Thurrock, Windsor & Maidenhead and Wandsworth, and in females in Rutland that were supressed in the initial upload of the liver disease profiles, are now presented in the November refresh.

October 2014

New Upper Tier Local Authority liver disease profiles launched