Lancet liver disease infographic
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Transcript of Lancet liver disease infographic
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blood
diabetes
endocrine / metabolic
liver
respiratory
neoplasms
cerebrovascular
ischaemic heart
circulatory
1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005
The UK population changed their drinking habits reflecting the a�ordability of stronger alcohol at home…
…and the number of people admitted to hospital for alcohol-related liver disease has almost doubled in a decade.
UK LIVER DISEASE CRISIS
Survival rates have improved for almost every disease of every organ in the last few decades, with one notable exception: liver disease1.
What’s driving this?
Annual deaths related to hepatitis C have quadrupled since 1996. It is estimated that around 75% of infected cases are unknown4.
Introduce a minimum price of 50p to reduce alcohol consumption.
reductionin obesityrate for women
reductionin obesityrate for men
20% TAXon soft drinks
3.8% 2.4%
Identify the 15-20% of NAFLD* cases likely to progress to severe liver disease when screening for other obesity-related diseases.
Increase medical provision with more specialists and liver clinics distributed across the UK.
Vaccinate at-risk populations for Hepatitis B and target use of antiretrovirals for people with hepatitis B and C
PROJECTED MINIMUM PRICE PER UNIT OF ALCOHOL AND RESULTING PERCENTAGE DECREASE IN CONSUMPTION5
50p
5p
10p
20p
5p
20p20p
10p
20p
20p
20p
5p
20p
20p
10p
50p
20p
50p
0% -0.1% -0.4% -1.1%-2.4%
-4.3%
-6.7%
-11.9%
-17.5%
What have the UK’s European neighbours done?
So what changes do we need to make in the UK?
A steady fall in cirrhosis deaths in France over the last 30 years corresponds to a proportionate fall in alcohol consumption over the period7.
Conversely, a 33% reduction in Finnish alcohol taxation in 2004 resulted in soaring rates of liver disease8.
Introduce a tax on soft drinks to reduce sugar intake9.
POLICY MAKERS
MEDICAL CARE
Of the 25% of the UK population with obesity, a vast majority has non-alcohol related fatty liver disease1.
2 3
1
France and Italy have seen a dramatic reduction in liver mortality whereas the UK and Finland have seen liver deaths rise more than fivefold1.
PERCENTAGE CHANGE IN STANDARDISED UK MORTALITY RATES (AGE 0–64) NORMALISED TO 100% IN 19701
0%20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970
300%
600%
BLOOD DIABETES CANCERENDOCRINE /METABOLIC
HEART DISEASE
RESPIRATORY CIRCULATORY STROKE
ALL ITEMS
BEER OFF SALES*WINE & SPIRITS OFF SALES*
WINE & SPIRITS ON SALES*BEER ON SALES*
1987 1990 1995 2000 2005 2010 2013
350
100
150
200
250
300
PRICE OF BEER, WINE & SPIRITS VERSUS INFLATION2
2002/
03
2003/
04
2004/0
5
2005/
06
2006/0
7
2007/0
8
2008/0
9
2009/
10
2010
/11
2011/
12
50,000
Admissions
Admissions
Deaths per 100,000
Number of deaths
Hours worked
*NAFLD = non alcoholic fatty liver disease
Price re-based to 100
* On-sales means in pubs and restaurants, o�-sales means liquor stores and supermarkets.
40,000
30,000
20,000
25,000
35,000
45,000
ALCOHOL-RELATED HOSPITAL ADMISSIONS3
HOSPITAL ADMISSIONS FOR NON-ALCOHOLRELATED FATTY LIVER DISEASE1
DEATHS FROM LIVER FAILURE OR LIVER CANCER IN THOSE WITH HEPATITIS C6
20,000
10,000
0
5,000
15,000
500
300
0
200
100
400
1998 2000 2005 2010 20122010200520001996
PERCENTANGE CHANGE IN STANDARDISED DEATH RATES1
40
35
30
25
20
15
10
5
0
UNITED KINGDOM ITALY NETHERLANDSSWEDEN NORWAYIRELANDFRANCE FINLAND
20101970 1975 1985 20051980 1990 1995 2000
Additionally, people in France diagnosed with hepatitis C are 6–12 times more likely to receive treatment than those diagnosed in the UK.4
HOURS AN INDUSTRY WORKER HAS TO WORK TO AFFORD HALF A LITRE OF VODKA IN FINLAND8
TOTAL WINE CONSUMPTION IN FRANCE, NORMALISED TO 100% IN 20007
2
1.5
1
0.5
01965 1970 1980 1990 2008
1990 1995 2000 2005 2009
250%
150%
0%
100%
50%
200%
2000
For further information on the recommendations of the Commission or to read the full report, visithttp://www.thelancet.com/commissions/crisis-of-liver-disease-in-the-UK
SOURCES
1 Williams R, Aspinall R, Bellis M, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in healthcare for liver disease and reducing premature mortality from the major lifestyle issue of excess alcohol consumption, obesity, and viral hepatitis. Lancet 2014; published online Nov 27, 2014. http://dx/doi.org/10.1016/S0140-6736(14)61838-9
2 ONS. Retail price index: all items versus beer, wine, and spirits, on and o� sales. 1987–2014. Newport; O�ce for National Statistics, 2014. http://www.ons.gov.uk/ons/datasets-and-tables/data-selector.html?table-id=2.1&dataset=mm23
3 HSCIC. Statistics on alcohol: England, 2014. Leeds; Health and Social Care Information Centre, 2014.
4 The Hepatitis C Trust. The UK vs Europe: losing the fight against hepatitis C, 2005. London; The Hepatitis C Trust and the University of Southampton, 2005.
5 British Medical Association. Reducing the a�ordability of alcohol: a briefing from the BMA Board of Science. London; British Medical Association, 2012.
6 Constella A, Goldberg D, Harris H, et al and Public Health England. Hepatitis C in the UK: 2014 report. London; Public Health England, revised July 31, 2014.
7 Jewell J, Sheron N. 2010. Trends in European liver death rates: implications for alcohol policy. Clin Med 2010; 10: 259–63.
8 Karlsson T, Mäkelä P, Österberg E, Tigerstedt C. A new alcohol environment. Trends in alcohol consumption, harms and policy: Finland 1990–2010. Nord Stud Alcohol Dr 2013; 27: 497–513.
9 Manyema M, Veerman LJ, Chola L. The potential impact of a 20% tax on sugar-sweetened beverages on obesity in South African adults: a mathematical model. PLoS One 2014; 9: e105287.
LIVER
20101970