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Lancet liver disease infographic
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Lancet liver disease infographic

  1. The UK population changed their drinking habits reflecting the affordability 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. reduction in obesity rate for women reduction in obesity rate for men 20%TAX on soft drinks 3.8% 2.4% Identify the15-20% 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 2004/05 2005/06 2006/07 2007/08 2008/09 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, off-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-ALCOHOL RELATED 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 0 1965 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, visit http://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 off sales. 1987–2014. Newport; Office 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 affordability 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
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