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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019
Thomas Peter Ignatius Pembroke, Gareth John, Berry Puyk, Keith Howkins, Ruth Clarke, Fidan Yousuf, Marek Czajkowski, Andrew Godkin, Jane Salmon, Andrew Yeoman
Thomas Peter Ignatius Pembroke, Andrew Godkin, Department of Gastroenterology and Hepatology, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom
Thomas Peter Ignatius Pembroke, Andrew Godkin, Division of Infection and Immunity, Cardiff University, Cardiff CF14 4XW, United Kingdom
Gareth John, Berry Puyk, Keith Howkins, Ruth Clarke, Digital Health and Care Wales, NHS Wales, Cardiff CF11 9AD, United Kingdom
Fidan Yousuf, Marek Czajkowski, Andrew Yeoman, Gwent Liver Unit, Royal Gwent Hospital, Newport NP20 2UB, United Kingdom
Jane Salmon, Public Health Wales, NHS Wales, Cardiff CF10 4BZ, United Kingdom
Author contributions: Pembroke TPI, John G, Salmon J, and Yeoman A developed the concept and design of the study; Yousuf F, Czajkowski M and Yeoman A collected data; Pembroke TPI, John G, Puyk B, Howkins K, Clarke R and Yeoman A analysed the data; Pembroke TPI, Godkin A, Salmon J, and Yeoman A prepared the manuscript.
Institutional review board statement: This study was initiated as a dedicated workstream of the Liver Disease Implementation Group and Public Health Wales to establish a Liver Registry for Wales as a core workstream for this project. This manuscript represents the report of this commissioned work. As such it not been reviewed by the university review board.
Informed consent statement: This study was conducted in keeping with the Helsinki declaration. The design of this study was discussed with the South Wales research ethics committee and was not classed as research requiring regulatory approvals by Health Research Authority, United Kingdom.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Thomas Peter Ignatius Pembroke, FRCP, MBBS, PhD, Doctor, Senior Lecturer, Department of Gastroenterology and Hepatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, United Kingdom. thomas.pembroke@wales.nhs.uk
Received: August 25, 2022
Peer-review started: August 29, 2022
First decision: October 17, 2022
Revised: November 17, 2022
Accepted: December 31, 2022
Article in press: December 31, 2022
Published online: January 27, 2023
BACKGROUND
Liver disease incidence and hence demand on hepatology services is increasing.
AIM
To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology services.
METHODS
The registry is populated by International Classification of Diseases-10 (ICD-10) code diagnoses for residents derived from mortality data and inpatient/day case activity between 1999-2019. Pseudo-anonymised linkage of: (1) Causative diagnoses; (2) Cirrhosis; (3) Portal hypertension; (4) Decompensation; and (5) Liver cancer diagnoses enabled tracking liver disease progression.
RESULTS
The population of Wales in 2019 was 3.1 million. Between 1999 and 2019 73054 individuals were diagnosed with a hepatic disorder, including 18633 diagnosed with cirrhosis, 10965 with liver decompensation and 2316 with hepatocellular carcinoma (HCC). Over 21 years the incidence of liver diseases increased 3.6 fold, predominantly driven by a 10 fold increase in non-alcoholic fatty liver disease (NAFLD); the leading cause of liver disease from 2014. The incidence of cirrhosis, decompensation, HCC, and all-cause mortality tripled. Liver-related mortality doubled. Alcohol-related liver disease (ArLD), autoimmune liver disease and congestive hepatopathy were associated with the highest rates of decompensation and all-cause mortality.
CONCLUSION
A 10 fold increase in NAFLD incidence is driving a 3.6 fold increase in liver disease in Wales over 21 years. Liver-related morbidity and mortality rose more slowly reflecting the lower progression rate in NAFLD. Incidence of ArLD remained stable but was associated with the highest rates of liver-related and all-cause mortality.
Core Tip: In this paper we describe the following: (1) Novel methodology for developing a national liver registry; (2) The incidence of liver disease has increased 3.6-fold in Wales between 1999-2019 driven by a 10-fold increase in non-alcoholic fatty liver disease (NAFLD); (3) 3-fold increase in cirrhosis, portal hypertension, decompensation and hepatocellular carcinoma, 2-fold increase in liver disease related mortality between 1999-2019; and (4) Actuarial tables of 10-year liver disease progression: Alcohol-related liver disease, autoimmune liver disease and congestive hepatopathy are associated with increased rates of decompensation and death compared to viral hepatitis and NAFLD. Description of the proportion of patients dying from liver disease as directly, as a contributory cause or where liver disease has not been recording on the death certificate.
