Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019

Figure 1 Modified CONSORT flow chart of liver disease diagnoses Wales 1999-2019. There were 336677 liver disease diagnoses recorded by routine inpatient, day case and death certificate coding. 257566 were duplicate diagnoses. 11059 aetiological diagnoses were considered redundant by superior tier diagnosis (e.g., hepatitis C virus is higher tier than hepatitis not specified in the same individual). The total number of index liver disease stage diagnoses are recorded. Each subsequent box shows the number of individuals within the total who have advanced liver disease.

Figure 2 Incidence of liver disease in Wales 1999-2019. A: The incidence of liver disease by aetiology recorded by routine coding following inpatient and day case admission and on death certification in Wales between 1999 and 2019; B: The European Age Standardised Rate of the incidence of liver disease in Wales between 2001 and 2019; C: The incidence of index diagnosis of liver disease stage (cirrhosis, portal hypertension, decompensation and liver cancer) caused by liver diseases of all aetiologies in Wales; D: All cause mortality in individuals with a preceding liver disease diagnosis in Wales 1999-2019. ArLD: Alcohol related liver disease; NALFD: Non-alcoholic fatty liver disease; HCV: Hepatitis C virus; HBV: Hepatitis B virus; A1AT: Alpha 1 antitrypsin deficiency.

Figure 3 Progression of liver diseases in Wales. The proportion of individuals at their most advanced stage of liver disease at baseline, 6 mo, 1, 2, 3, 5 and 10 years in Wales by aetiology. A: Aetiology (stage 1) diagnosis alone (not progressed); B: Cirrhosis (stage 2); C: Portal hypertension (stage 3); D: Decompensation (stage 4); E: Liver cancer (stage 5); F: All cause mortality (stage 6).

Figure 4 Liver disease diagnoses on death certificates reported for individuals in the Wales Liver Disease Registry 1999-2019. A: The number of liver disease diagnoses that were reported as the underlying cause, reported on the death certification and certificates which were did not have any mention of liver disease for all individuals with an index diagnosis of liver disease in Wales between 1999-2019; B: The proportion of deaths by aetiology that were recorded with an underlying liver disease cause, liver disease reported on the death certificate or liver disease was not mentioned. ArLD: Alcohol related Liver Disease; A1AT: Alpha 1 antitrypsin deficiency.