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

Area of Science:

• Hepatology
• Public Health
• Epidemiology

Background:

• Increasing liver disease incidence necessitates better understanding of hepatology service demands.
• Rising prevalence of liver disorders impacts healthcare resource allocation.

Purpose of the Study:

• To analyze liver disease incidence and natural history trends in Wales.
• To provide data for optimizing hepatology service provision.

Main Methods:

• Utilized International Classification of Diseases-10 (ICD-10) codes from mortality and inpatient data (1999-2019).
• Linked diagnoses for causative factors, cirrhosis, portal hypertension, decompensation, and liver cancer.
• Tracked liver disease progression using pseudo-anonymised data linkage.

Main Results:

• Over 21 years, liver disease incidence increased 3.6-fold, driven by a 10-fold rise in non-alcoholic fatty liver disease (NAFLD).
• Incidence of cirrhosis, decompensation, and hepatocellular carcinoma (HCC) tripled; liver-related mortality doubled.
• Alcohol-related liver disease (ArLD) had stable incidence but the highest rates of decompensation and mortality.

Conclusions:

• NAFLD is the primary driver of increased liver disease burden in Wales.
• Liver-related morbidity and mortality increased, though at a slower rate than NAFLD incidence.
• ArLD remains a significant cause of mortality despite stable incidence.