Liver disease profiles, July 2023 update
Published 4 July 2023
Applies to England
© Crown copyright 2023
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New in this update
New hospital admission data has been added to the Liver Disease Profiles
The liver profile, from which this is a summary, was developed by the national liver disease intelligence service following recommendations in March 2014 from the All-Party Parliamentary Hepatology Group (APPHG) inquiry into improving outcomes in liver disease chaired by the late Sir David Amess.
This update includes new data for 2 indicators in the liver disease profile:
- hospital admissions for liver disease in persons, males and females
- hospital admissions for alcoholic liver disease in persons, males and females
The hospital admission indicators for the financial year ending 2022 have been calculated using the new 2021 census-based populations. This is no longer comparable with previous data that was based on 2011 census-based populations. The back-series data has therefore been temporarily removed and will be recalculated and published as the rebased back-series population estimates become available. 2021 census-based population data is currently unavailable at an ICB level so there is no available data for ICBs.
Previous data is available by request from liverdisease@dhsc.gov.uk or by clicking on the links within the indicator ‘definitions’ on the fingertips platform.
As part of the ongoing work in maintaining the profiles, indicators and methods are regularly reviewed. The 2 updated HES based indicators in the liver profile have been calculated using a revised methodology to obtain the confidence intervals. The Dobson and Byar’s method previously used to calculate the confidence intervals presumes each admission in the year are independent events. For liver disease however, it is common that a person might attend the hospital several times during the year. To account for this non-independence of events, we are applying a Dobson and Byar’s method with an adjusted variance that takes into account the actual number of people and the number of multiple admissions. Full technical details of the new methodology will be made available soon and can be requested.
So what difference has it made?
The new method has the effect of widening the confidence intervals. Table 1 presents hospital admissions due to liver disease in the financial year ending 2022 for England for both the previous and new method.
Table 1: difference in confidence intervals between the previous and new method. Hospital admission rate due to liver disease, per 100,000 population, England, in the financial year ending 2022
| Count | Denominator | Value (DSR per 100,000) | Lower 95% CI | Upper 95% CI | Lower 99.8% CI | Upper 99.8% CI | |
|---|---|---|---|---|---|---|---|
| Previous method | 82,290 | 56,536,419 | 150.59 | 149.56 | 151.63 | 148.97 | 152.22 |
| New method | 82,290 | 56,536,419 | 150.59 | 148.28 | 152.91 | 146.95 | 154.26 |
Figure 1: chart showing difference in confidence intervals between the previous and new method. Hospital admission rate due to liver disease, per 100,000 population, England, in the financial year ending 2022
The confidence interval shows where we expect the true result to lie 99.8% and 95% of the time. By taking into account a person’s multiple admissions, the confidence interval is wider indicating less certainty around where the true value lies.
Table 2 shows the number of upper tier local authority (UTLA) areas in relation to their significance to the England value using both the previous and new confidence interval method. More areas are now in the ‘similar’ to England category.
Table 2: number of UTLAs in each category of significance in relation to the England value using the previous and new method. Hospital admission rate due to liver disease, per 100,000 population, England, in the financial year ending 2022
| Persons | Previous method | New method |
|---|---|---|
| Higher 99.8% | 40 | 13 |
| Higher 95% | 13 | 16 |
| Similar | 40 | 80 |
| Lower 95% | 7 | 13 |
| Lower 99.8% | 49 | 27 |
| Suppressed | 3 | 3 |
| Total ULTAs | 152 | 152 |
Main findings
This update shows:
-
the number of admissions to hospital where the primary diagnosis was liver disease rose by 22.0% in the financial year ending 2022 from 82,290 compared to 67,458 in the financial year ending 2021 (the first full year of the COVID-19 pandemic)
-
there was an 4-fold difference in admission rates for liver disease between the counties and unitary authorities (UA) with the highest and lowest rate 282.0 per 100,000 population in Nottingham and 63.6 per 100,000 population in Wokingham in the financial year ending 2022)
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at a regional level, overall rates of liver disease admissions to hospital remain highest in the north of England with the North East having the highest rate of 190.1 per 100,000 population in the financial year ending 2022
-
the number of admissions to hospital where the primary diagnosis was alcoholic liver disease rose by 11.7% in the financial year ending 2022 from 27,419 compared to 24,544 in the financial year ending 2021 (the first full year of the COVID-19 pandemic)
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there was an 11-fold difference in admission rates for alcoholic liver disease between the counties and unitary authorities (UA) with the highest and lowest rate (145.3 per 100,000 population in Leeds and 13.4 per 100,000 population in Wokingham in the financial year ending 2022)
Summary
Hospital admission rates due to liver disease
This indicator has been updated with data for the financial year ending 2022 for males, females and persons. Previous data has been removed as it is no longer comparable with the new data. It is however available to download as a csv file. Back series data will be recalculated when the new 2021 census rebased population is available. Data for this indicator is available for males, females and persons and for the geographies of England, region, UTLA, LTLA. ICB data will be updated when new 2021 census based population for small area estimates are made available.
In the financial year ending 2022, there were 82,290 hospital admissions due to liver disease in England, a rate of 150.6 (148.3-152.9) per 100,000 population. This compares with 67,458 admissions in the financial year ending 2021 (the first full year of the COVID-19 pandemic). The number of hospital admissions due to liver disease has increased by almost 47% compared to 10 years ago, in the financial year ending 2012, when there were 56,143 admissions.
Figure 2: number of hospital admissions due to liver disease in persons, England, in the financial year ending 2011 to the financial year ending 2022
During the same time period there were 49,992 hospital admissions due to liver disease for males, a rate of 189.7 (185.8 to 193.5) per 100,000 population and 32,288 hospital admissions for females, a rate of 114.3 (111.7-117.0) per 100,000 population. Proportionally 60.8% were male and 39.2% female. These proportions have remained stable over the last decade.
The North East region experienced this highest rates of hospital admissions due to liver disease in the financial year ending 2022, with a rate of 190.1 (178.6 to 201.7) per 100,000 population. South East had the lowest rate of 126.7 (122.4 to 131.0) per 100,000 population. Whilst the North East had the highest rate, they experienced the lowest numbers of 5,095 admissions where as the South East region had the lowest rate but experienced the highest number of admissions 11,685.
Across the county and unitary authority (UA) areas (sometimes referred to as upper tier local authorities (UTLA)) there is a 4-fold difference between the rate of admissions for liver disease for the financial year ending 2022. Leeds experienced the highest rates, 282.0 (243.8 to 321.4) per 100,000 population (1,990 admissions), while the lowest rate was in Wokingham, 63.6 (49.4 to 79.9) per 100,000 population (105 admissions).
In terms of counts, the upper tier local authority with the highest number of hospital admission due to liver disease was Nottinghamshire 2,070 admissions, followed by Leeds, Lancashire, Hampshire and Kent. Bracknell Forest had the lowest count of 90 admissions.
At the more granular level of district and unitary authority (UA) areas (sometimes referred to as lower tier local authorities (LTLA)) there is a 5-fold difference between the rate of admissions for liver disease in the financial year ending 2022. Rushcliffe experienced the highest rates, 316.7 (216.9 to 424.2) per 100,000 population (400 admissions), whilst the lowest rate was in Wokingham, 63.6 (49.4 to 79.9) per 100,000 population (105 admissions).
In terms of counts, the lower tier local authority with the highest number of hospital admission due to liver disease was Leeds 1,990 admissions, followed by Birmingham, Cornwall, County Durham and Manchester. Oadby and Wigston, Ribble Valley, West Devon, Tandridge each had the lowest count of 65 admissions.
Figure 3: hospital admission rates due to liver disease, directly standardised rate per 100,000 population by LTLA, England, in the financial year ending 2022
Hospital admission rates for alcoholic liver disease
This indicator has been updated with data for the financial year ending 2022 for males, females and persons. Previous data has been removed as it is no longer comparable with the new data. It is however available to download as a csv file. Back series data will be recalculated when the new 2021 census rebased population is available. Data for this indicator is available for males, females and persons and for the geographies of England, region, UTLA. ICB data will be updated when new 2021 census based population for small area estimates are made available.
In the financial year ending 2022, there were 27,419 hospital admissions due to alcoholic liver disease in England, a rate of 50.3 (48.9-51.7) per 100,000 population. This compares 24,544 admissions in the financial year ending 2021 (the first full year of the COVID-19 pandemic). The number of hospital admissions due to liver disease has increased by 65.5% compared to 10 years ago, in the financial year ending 2012, when there were 16,571 admissions.
Figure 4: number of hospital admissions due to alcoholic liver disease in persons, England, in the financial year ending 2011 to the financial year ending 2022
During the same time period there were 18,342 hospital admissions due to alcoholic liver disease for males was, a rate of 69.0 (66.6 to 71.4) per 100,000 population and 9,075 hospital admissions for females, a rate of 32.6 (31.1 to 34.1) per 100,00 population. Proportionally 66.9% were male and 33.1% female. These proportions have altered slightly over the last decade with the female proportion increasing by 2% over that time.
Figure 5: hospital admission rates for alcoholic liver disease, per 100,000 population, for England Regions, in the financial year ending 2022
The North East was the region with the highest rate of hospital admissions for liver disease (78.6 (71.8 to 85.6) per 100,000 population), followed by Yorkshire and the Humber (68.6 (62.9 to 74.8) per 100,000 population) and North West (63.2 (59.1 to 67.3) per 100,000 population). East of England was the region with the lowest rate (35.3 (32.3 to 38.5) per 100,000 population).
There was a 11-fold difference in admission rates for alcoholic liver disease for the counties and unitary authorities with the highest and lowest rate (145.3 (115.0 to 177.0) per 100,000 population in Leeds and 13.4 (7.8 to 21.2) per 100,000 population in Wokingham).
The rate of hospital admissions for alcoholic liver disease is twice as high in males (69.0 (66.6 to 71.4) per 100,000 population) than for females (32.6 (31.1 to 34.1) per 100,000 population) in England. The county and unitary authority with the largest difference between male and female rates (excluding areas with suppressed counts) was Ealing and Brent, both with a 5.8-fold difference. The rate for Ealing was (79.9 (51.9 to 111.7) per 100,000 population in males and (13.7 (5.7 to 24.7) per 100,000 population in females). The rate for Brent was (62.6 (41.2 to 87.4) per 100,000 population in males and (10.7 (5.3 to 18.5) per 100,000 population in females. Calderdale had the highest rate for the male population, 204.5 (108.8 to 310.8) per 100,000 population, almost 3 times higher than the England rate. In the female population, Nottingham had the highest rate, 103.0 (39.5 to 175.2) per 100,000 population.
Hospital admission rates due to non-alcoholic fatty liver disease
This indicator update is on hold as we review the application of a new confidence interval method for crude rates to take into account repeat admissions. We are planning to update this indicator when we are able to update the back-series based on the 2021 census rebased populations.
Background and further information
Liver disease is almost entirely preventable with the major risk factors: alcohol, obesity and hepatitis B and C accounting for up to 90% of cases.
The liver disease profiles provide an invaluable resource 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 work of health and wellbeing boards presenting local key statistics and highlighting questions to ask locally about current action to prevent liver disease.
The website contains data for upper tier local authorities, former government office regions, England and where available lower tier local authorities and ICBs.
Further details about the profile methodology are available within the definitions section of the online version of the liver disease profile.
Responsible statistician, product lead: Liz Rolfe, Julia Verne
For queries relating to this document, please contact: liverdisease@dhsc.gov.uk