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MAFLD burden on the Spanish National Health System. A call to action
Daniel Riado Mínguez1, María Luisa Gutiérrez García1, Lorena Jara Fernández1
1Aparato Digestivo, Hospital Universitario Fundación Alcorcón, España.
Insights
Metabolic associated liver disease (MAFLD) is now the primary cause of liver fibrosis in Spain. This condition significantly burdens the Spanish National Health System, necessitating urgent attention and resource allocation.
Area of Science:
- Hepatology
- Public Health
- Internal Medicine
Background:
- Metabolic associated liver disease (MAFLD) presents a growing concern for healthcare systems.
- Significant fibrosis and cirrhosis affect a substantial portion of the Spanish population.
- Previous declines in liver disease burden were linked to reduced alcohol consumption and improved HCV treatments.
Purpose of the Study:
- To analyze the current and future impact of MAFLD on the Spanish National Health System.
- To identify the leading causes of liver fibrosis in Spain.
- To highlight socioeconomic determinants of chronic liver disease.
Main Methods:
- Review of epidemiological data on liver disease prevalence in Spain.
- Analysis of hospitalization and mortality trends related to cirrhosis.
- Assessment of etiological factors in patients with significant liver fibrosis.
Main Results:
- MAFLD is identified as the predominant cause of liver fibrosis in Spain, with 90% of affected patients lacking viral hepatitis or excessive alcohol consumption.
- Despite a decrease in cirrhosis-related hospitalizations and mortality, MAFLD poses a significant future burden.
- Lower income and disadvantaged areas are associated with higher liver-related mortality, indicating socioeconomic disparities.
Conclusions:
- MAFLD is the leading cause of liver fibrosis in Spain, requiring proactive management strategies.
- The Spanish National Health System must prepare for the escalating burden of MAFLD.
- Addressing socioeconomic factors is crucial for mitigating chronic liver disease outcomes.
Abstract:
We have read the editorial by Crespo et al on the metabolic associated liver disease (MAFLD) foreseeable burden on the Spanish National Health System over the next years. Between 0.35-0.4% of Spanish population has cirrhosis and more than one million people has significant fibrosis, assessed by ET ≥ 9 kPa. Compared with general population, patients with cirrhosis have more comorbidities and use healthcare resources more frequently. Recent data show a decrease of 24% in hospitalization due to cirrhosis during the period 2005-2014 in our country. These data predate the availability of direct antiviral agents against HCV. A 20% reduction of cirrhosis-related mortality during the period 2006-2018 was observed, as with other Southern European countries. This decline reflects a reduction of alcohol consumption in the last decades. More recently, 90% of patients with significant liver fibrosis were negative for HCV or HBV, did not consume harmful amounts of alcohol and showed components of metabolic syndrome thereby suggesting that MAFLD is the current leading cause of liver fibrosis in Spain. Some studies found that disadvantaged areas in the Community of Madrid had higher liver-related mortality, highlighting that lower income is another socioeconomic determinant of chronic liver disease.
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