Is preventable liver disease a bigger problem in certain parts of the country?

One of the primary goals for the health service outlined in the 10 Year Health Plan for England is to move "from sickness to prevention”. Under this pledge, various initiatives have been proposed to enable healthier lifestyle choices like expanding weight loss services, improving nutritional information and introducing warning messages for alcoholic drinks.

The need for these initiatives is made clear by the increase in obesity prevalence and alcohol-related admissions and mortality in recent years. Along with chronic viral hepatitis, being overweight or obese and high alcohol consumption are two of the main risk factors for liver disease (any condition that impairs the liver’s normal functioning).

Since 1970, mortality rates from liver disease in the UK have increased at least four-fold. Most cases are considered preventable, but many patients are not diagnosed until they are at a late stage of the disease’s progression. The British Liver Trust has found that three-quarters of people with cirrhosis (permanent scarring of the liver due to long-term damage) are diagnosed when symptoms become life-threatening, exemplifying the need for early detection pathways. Having a combination of risk factors can worsen risk, as obesity increases the toxicity caused by alcohol to the liver.

To better understand how mortality from preventable liver disease is distributed across England, we mapped the geographical variation of preventable liver disease at the ICB level in 2022 (which is the last year where the data was available at this level).

In 2022, the data revealed a significant north-south divide in England, with rates of preventable mortality from liver disease disproportionately higher in the northernmost regions than the southernmost areas. The highest mortality rate was observed in Greater Manchester ICB and Black Country ICB (28 per 100,000 people), followed by Lancashire and South Cumbria ICB and Northeast and North Cumbria ICB. Buckinghamshire, Oxfordshire and Berkshire West ICB had the lowest mortality rate at 12.9 per 100,000.

Given that two of the primary risk factors for preventable liver disease are obesity and alcohol consumption, we decided to investigate whether they are distributed in a similar pattern. When looking at the obesity prevalence in those aged 16 and older, the northernmost regions had the highest proportions of their populations reported as obese. When plotting harmful drinking (over 14 units per week), the highest rates were in the northern and southernmost parts of the country, but the mortality rate in those areas tell a very different tale. One possibility for higher rates of mortality in the north may be the combination of high obesity prevalence and higher rates of harmful drinking, but the causes of our observations are not fully understood.

The data revealed that specific areas fare worse in terms of preventable liver disease, and the NHS is accordingly conducting diagnostic interventions in the communities that need it most through the deployment of scanning trucks. Many ICBs have also made successful local efforts to reduce mortality by screening high-risk patients and detecting disease early (the Scarred Liver Project in Nottingham being one example). Continuing these interventions, particularly in regions that need them most, may help even out inequalities, prevent mortality, and change the trajectory for those in England more likely to die of a preventable disease.