The Lancet,
Volume 384, Issue 9958, Pages 1953 – 1997, 29 November 2014
doi:10.1016/S0140-6736(14)61838-9
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Published Online: 27 November 2014
Copyright © 2014 Elsevier Ltd All rights reserved.
Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis
Prof Roger Williams MD a 
, Richard Aspinall MBChB b, Prof Mark Bellis DSc c, Ginette Camps-Walsh DMS d, Prof Matthew Cramp MD e f, Prof Anil Dhawan MD g, James Ferguson MD h, Dan Forton PhD i, Prof Graham Foster FRCP j, Prof Sir Ian Gilmore MD k, Prof Matthew Hickman PhD l, Mark Hudson FRCP m, Prof Deirdre Kelly MD n, Andrew Langford PhD o, Prof Martin Lombard MD p, Louise Longworth PhD q, Natasha Martin DPhil l, Kieran Moriarty FRCP r, Prof Philip Newsome PhD s, Prof John O’Grady MD g, Rachel Pryke MRCGP t, Harry Rutter MB BChir u, Stephen Ryder FRcP v, Prof Nick Sheron MD w, Tom Smith PhD x
Liver disease in the UK stands out as the one glaring exception to the vast improvements made during the past 30 years in health and life expectancy for chronic disorders such as stroke, heart disease, and many cancers. Mortality rates have increased 400% since 1970, and in people younger than 65 years have risen by almost five-times. Liver disease constitutes the third commonest cause of premature death in the UK and the rate of increase of liver disease is substantially higher in the UK than other countries in western Europe. More than 1 million admissions to hospital per year are the result of alcohol-related disorders, and both the number of admissions and the increase in mortality closely parallel the rise in alcohol consumption in the UK during the past three decades. The new epidemic of obesity is equally preventable. Of the 25% of the population now categorised as obese, most will have non-alcoholic fatty liver disease many (up to 1 in 20 of the UK population) will have ongoing inflammation and scarring that finally leads to cirrhosis. Of those patients with cirrhosis, 5—10% will get liver cancer. This increasing burden of liver disease is added to by chronic viral hepatitis; annual deaths from hepatitis C have almost quadrupled since 1996 and about 75% of people infected are estimated to be still unrecognised. The same applies to chronic hepatitis B infection, in which progression to cirrhosis and liver cancer also happens. The number of silently infected individuals in the UK is increasing every year as a result of immigration from countries with a high prevalence of hepatitis B and hepatitis C infections.
