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

Pembroke, Thomas Peter Ignatius ORCID: https://orcid.org/0000-0002-2600-2034, John, Gareth, Puyk, Berry, Howkins, Keith, Clarke, Ruth, Yousuf, Fidan, Czajkowski, Marek, Godkin, Andrew ORCID: https://orcid.org/0000-0002-1910-7567, Salmon, Jane and Yeoman, Andrew 2023. Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019. World Journal of Hepatology 15 (1) , pp. 89-106. 10.4254/wjh.v15.i1.89

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Abstract

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 allcause 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Baishideng Publishing Group
ISSN:	1948-5182
Date of First Compliant Deposit:	22 March 2023
Date of Acceptance:	31 December 2022
Last Modified:	09 May 2023 11:16
URI:	https://orca.cardiff.ac.uk/id/eprint/157885

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