Alcohol linked to 25% increase in liver disease deaths

By Dr. Ananya Mandal, MDMar 25 2012

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.

Andrew Langford, Chief Executive of the British Liver Trust, said, “This report clearly highlights that liver patients have been, and continue to be, failed by our healthcare system. Liver disease has remained the poor relation in comparison to other big killers such as cancer and heart disease, yet liver disease is the only big killer on the rise. The increasing numbers of people with, and dying from, liver disease leaves the UK at breaking point and we cannot afford to overlook these patients any longer.” “The current nature of the disease means that people are diagnosed late in their condition, this exposes the inadequacies in our healthcare system in identifying patients early and also the lack of will to invest in prevention strategies that will have a serious impact such as alcohol pricing, taxing high fat foods and testing for viral hepatitis,” he said.

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.

The report's lead author, Julia Verne, said it represented the first summary of key facts, on which future discussions could be built. “It is crucial that commissioners and providers of health and social care services know the prevalence of liver disease in their local areas.”

Claire Henry, director of the National End of Life Care Programme, added, “Clinicians caring for people with liver disease need to be having conversations with them about end of life care. This is exceptionally challenging for those with liver disease, who are often younger, come from ethnically diverse or deprived backgrounds, and may feel stigma associated with the disease. It is additionally complicated for those dying of alcohol-related liver disease, who may also have mental health or drug dependence problems, and little family or social support. These factors make good communication about end of life care so important.”

The Department of Health said, “These figures are a stark reminder of the preventable damage that eating too much and drinking too much alcohol can do. Urgent action is needed to halt this trend. Our upcoming liver strategy will set out our plans on this issue, drawing on our plans to tackle problem drinking and obesity.”

The recommended daily limits for alcohol consumption are no more than three-to-four units of alcohol a day for men and 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.