Official Statistics

Liver disease profile, December 2024 update

Published 3 December 2024

Applies to England

What’s new

Five mortality indicators in the liver disease profile have been updated, providing new data for the single year of 2023 and for the 3-year period 2021 to 2023. The indicators present data for premature mortality being defined as those under the age of 75 years. Data has been calculated for lower layer super output area (LSOA) deprivation deciles where possible.

The following indicators have been updated:

• mortality from liver disease in persons, males and females aged under 75
• mortality from alcoholic liver disease in persons, males and females aged under 75
• mortality from non-alcoholic fatty liver disease (NAFLD) in persons aged under 75
• mortality from hepatitis B related end-stage liver disease or hepatocellular carcinoma in persons aged under 75
• mortality from hepatitis C related end-stage liver disease or hepatocellular carcinoma in persons aged under 75

Introduction

The profile presents data for key indicators around liver disease for England, the regions, and where possible, county and unitary authorities (UAs) and district and UAs. Some of the indicators are also presented by sex and level of deprivation to highlight inequalities in liver disease outcomes and care between these groups.

Main findings

This update shows:

• the England rate of premature deaths from liver disease increased by 42% from 2001 to 2023 - with the number of deaths rising from 6,140 in 2001 to 10,858 deaths in 2023
• the number of premature deaths from alcoholic liver disease rose by 3.6% in 2023 to 5,984 compared to 5,776 in 2022
• the England rate of premature deaths from alcoholic liver disease between 2001 to 2023 has increased by almost 60%.
• in 2023 there were 345 premature deaths from NAFLD; in 2022 there were 323
• in 2023 there were 84 premature deaths from hepatitis B related end-stage liver disease or hepatocellular carcinoma
• the number of premature deaths from hepatitis C in 2023 has decreased in the last 2 years with 212 deaths in 2023
• people living in the most deprived deprivation deciles of England experience worse rates of liver diseases than people in more affluent areas

Detailed findings

Premature mortality rate due to liver disease

The mortality rate from liver disease in persons aged under 75 years in England has been increasing and is the highest rate it has been since 2001. The rate in 2023 is 21.9 (95% confidence interval 21.5 to 22.3) per 100,000 population aged under 75 compared with a rate of 15.4 (15.0 to 15.8) in 2001. The 2023 rate is significantly higher than before the pandemic in 2019 when the rate was 18.9 (18.5 to 19.3).

In 2023 the number of premature deaths from liver disease for males was 6,929, and for females 3,929. The rate in males has risen by 46.1% and females by 36.9% since 2001.

Premature mortality due to alcoholic liver disease

In 2023, there were 5,984 premature deaths from alcoholic liver disease in England. The rate in 2023 was not significantly different from the previous year but is significantly higher than before the pandemic:

• in 2023 the rate was 12.0 (11.7 to 12.3) per 100,000 population aged under 75
• in 2022 the rate was 11.6 (11.3 to 11.9) per 100,000 population aged under 75
• in 2019 the rate was 9.1 (8.8 to 9.4) per 100,000 population aged under 75

Since 2001 the number of premature deaths from alcoholic liver disease has increased by 93.2% in England, rising by 93.5% in males and 92.6% in females.

Alcohol is the most common cause of liver disease in England. Alcoholic liver disease accounted for 55% of premature liver disease deaths in 2023. Analyses of hospital admissions for alcoholic liver disease show a general increase in trends.

Figure 1: directly standardised rates of death from liver disease and alcoholic liver disease, persons aged under 75 years, England, 2001 to 2023

Rates of premature death from alcoholic liver disease were significantly higher in Northern and Midland regions of England.

Across the county and UAs, rates varied. Sunderland had the highest rate at 25.4 (19.7 to 32.3) per 100,000 population aged under 75, this was almost 5 times higher than the lowest rate for Barnet at 5.3 (3.1 to 8.5) per 100,000 population. Kent had the highest number of premature deaths from alcoholic liver disease at 165.

People living in the most deprived areas of the country experience worse rates of premature death due to alcoholic liver disease. When measured across LSOAs, using the 2019 index of multiple deprivation (IMD), the difference for premature death due to alcoholic liver disease in 2022 was 4.6-fold.

Figure 2: variation in premature mortality rates from alcoholic liver disease 2022 by LSOA21 deprivation deciles in England (IMD 2019)

Premature mortality due to non-alcoholic fatty liver disease

In 2023 there were 345 deaths, from NAFLD, a rate of 0.66 (0.59 to 0.73) per 100,000 population aged under 75. The rate remains significantly higher than before the pandemic in 2019 when the rate was 0.46 (0.40 to 0.52).

NAFLD is the accumulation of fat within the liver that is not caused by alcohol consumption. It’s usually seen in people who are overweight or obese. In England, around two-thirds of adults are above a healthy weight, and almost half are living with obesity. An estimated 1 in 3 children leaving primary school are overweight or living with obesity, with 1 in 5 living with obesity. Tackling obesity can prevent NAFLD.

Regional figures show the North East of England has the highest rates of premature death from NAFLD with a rate of 1.27 (0.86 to 1.80) per 100,000 population aged under 75.

In 2022 rates of premature death from NAFLD were higher in areas which are more deprived. Across the LSOA level deprivation deciles for England there was 6.4-fold difference.

Premature mortality from hepatitis B related end-stage liver disease or hepatocellular carcinoma

The rate of premature mortality from hepatitis B related end-stage liver disease or hepatocellular carcinoma have not varied significantly since 2001.

Premature mortality from hepatitis C related end-stage liver disease or hepatocellular carcinoma

In 2023 the rate of hepatitis C related end-stage liver disease or hepatocellular carcinoma mortality was 0.40 (0.35 to 0.46) per 100,000 population aged under 75.

The trend in rate of premature deaths from hepatitis C related end-stage liver disease or hepatocellular carcinoma mortality peaked in 2015 with a rate of 0.67 (0.60 to 0.75) per 100,000 population and 338 premature deaths. Both the rate and number have been steadily coming down since.

The UK Health Security Agency’s Hepatitis C in England 2023 report suggests the decline in mortality is likely to be the result of increased access to testing and treatment by direct-acting antivirals (DAA) drugs that were introduced in 2015, particularly for individuals with more advanced disease. Early treatment is vital as this prevents progression to cirrhosis and prevents hepatitis C virus related mortality.

Figure 3: crude rates of death from non-alcoholic liver disease, hepatitis B and C end stage liver disease or hepatocellular carcinoma, persons aged under 75 years, England, 2001 to 2023

Methodology

Liver disease is defined in the profile including primary liver cancer and uses the underlying cause of death field only so is likely to be an underestimate of the true number of premature deaths.

Revisions

Due to corrections to mid-2022 populations at national and sub-national levels, to account for updated estimates of international migration in England and Wales, data has been revised for the single year of 2022 and for the 3-year average of 2020 to 2022. This change has had a minor impact on the rates for these time periods.

The IMD 2019 has been adjusted to align with 2021 LSOAs so rates for deciles may have had a small change from previously published data.

Integrated care board data has not been refreshed as we are awaiting the release of the Office for National Statistics mid-year population estimates for LSOAs.

Background and further information

The liver disease profile provides resources relating to one of the main causes of premature mortality nationally; a disease whose mortality rates are increasing in England, while decreasing in most EU countries. The local authority profiles will support the development of joint strategic needs assessments and the work of health and wellbeing boards presenting local key statistics and highlighting questions to ask locally about current action to prevent liver disease.

Further details about the profile methodology are available within the definitions section of the liver disease profile.

More information around alcohol and obesity are available in the alcohol profile and obesity profile.

For queries relating to this document, please contact: [email protected].