People living with liver cirrhosis face some of the poorest outcomes of any major long-term condition, yet liver disease continues to receive disproportionately little attention from health policymakers, according to a major new study published today. The findings also raise important questions about the recent Government decision to scale back the scope of the national liver disease transformation programme, at a time when liver disease is one of the few major long-term conditions for which outcomes are continuing to deteriorate.
The analysis, led by Dr Hamish Innes, at Glasgow Caledonian University, with colleagues at the Universities of Nottingham and Edinburgh, used data from more than 1.6 million adults in England. They compared cirrhosis with 15 other long-term conditions, including heart failure, chronic kidney disease, type 2 diabetes, dementia and advanced cancer. The findings paint a stark picture of a condition associated with high mortality, significant health inequalities, multiple co-existing health conditions and worsening outcomes over time.
Professor Neil Guha, senior author of the study and Consultant Hepatologist at Nottingham University Hospitals NHS Trust and the University of Nottingham, said: “This study demonstrates that cirrhosis is an outlier among long-term conditions. Patients experience a combination of exceptionally poor outcomes, high levels of deprivation, multiple co-existing health conditions and late diagnosis. Yet despite this substantial burden, liver disease often receives less attention than other major health conditions. We hope these findings help inform future decisions about healthcare priorities and resource allocation.“
The study found that people with cirrhosis had a mortality risk comparable to some of the most serious conditions in healthcare. Unlike many other major diseases, outcomes are not improving. While mortality rates from conditions such as coronary artery disease have declined, deaths associated with cirrhosis have increased over the past decade.
The research also highlights the close relationship between liver disease and health inequality. People with cirrhosis were among the most likely to live in the most deprived communities and frequently experienced multiple other health conditions at the same time, creating substantial challenges for both patients and healthcare services.
Importantly, the study suggests that many people are not diagnosed until their disease is already advanced. Among those who later required hospital admission for cirrhosis, only a small minority had previously reported a diagnosis, pointing to missed opportunities for earlier identification and intervention.
Many of the factors driving liver disease are well understood. Rising levels of obesity and metabolic ill health are contributing to increasing rates of metabolic dysfunction-associated steatotic liver disease (MASLD), while alcohol-related liver disease remains a major cause of preventable illness and death.
The findings come at a time when liver disease is becoming an increasingly important challenge for the NHS. It is one of the few major causes of premature death that continues to rise, despite the fact that early identification and intervention can prevent progression to advanced disease in many cases.
Vanessa Hebditch, Director of Communications and Policy at Liver UK, said: This study should be a wake-up call for policymakers. It shows that cirrhosis is not simply another long-term condition. It is one of the most lethal, most unequal and most overlooked health challenges facing the UK today.
“While outcomes for many major diseases have improved over recent decades, liver disease is moving in the wrong direction. Too many people are being diagnosed late, when opportunities to prevent serious harm have already been missed. What makes this particularly frustrating is that we know what works. Earlier identification of liver disease, better assessment of people at risk, action to prevent obesity and alcohol harm, and more joined-up care could save lives and reduce pressure on the NHS.
The burden of liver disease now demands the same level of policy attention afforded to other major long-term conditions. The evidence is clear: liver disease can no longer be the forgotten condition.”
Read the full paper here: Epidemiological comparison of cirrhosis to other long-term health conditions in the United Kingdom – PubMed
