Official Statistics

Liver disease profile, April 2024 update

Updated 8 April 2024

Applies to England

What’s new

New mortality data for the calendar year 2022 and hospital admission data for the financial year ending 2023 has been added to the liver disease profile, trend data has also been made available.

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
• hospital admissions for liver disease in persons, males and females
• hospital admissions for alcoholic liver disease in persons, males and females
• hospital admissions for non-alcoholic fatty liver disease (NAFLD) in persons

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 almost 40% from 2001 to 2022 (10,593 deaths in 2022, 6,140 deaths in 2001)
• rates of premature death from liver disease in females has risen more rapidly over the last 20 years than in males
• the England rate of premature deaths from alcoholic liver disease in 2022 was 11.6 per 100,000 population aged under 75 (5,776 deaths)
• in the past 20 years, the number of premature deaths from alcoholic liver disease has increased by 61.3% in England. Rates increased by 35.9% over the same period.
• in 2022, there were 323 premature deaths from non-alcoholic fatty liver disease
• in 2022, there were 74 premature deaths from hepatitis B related end-stage liver disease or hepatocellular carcinoma, a rate of 0.14 (0.11 to 0.18) per 100,000 population aged under 75
• the number of premature deaths from hepatitis C in 2022 has plateaued in the last 3 years with numbers for 2022, 2021 and 2020 at 233, 241, 237, respectively
• hospital admission rates due to liver disease continue to rise. In the financial year ending 2023 it has risen to 155.2 (152.9 to 157.5) per 100,000 population from a rate of 150.6 (148.2 to 152.9) the previous financial year
• the number of admissions to hospital where the primary diagnosis was alcoholic liver disease was 27,085 in the financial year ending 2023

Detailed findings

Premature mortality rate due to liver disease

The mortality rate from liver disease in persons aged under 75 years England has been increasing and is the highest rate it has been since 2001. The rate in 2022 is 21.4 (95% confidence interval 21.0 to 21.8) per 100,000 population aged under 75 compared with a rate of 15.4 (15.0 to 15.8) in 2001.

In 2022 the number of premature deaths from liver disease for males was 6,664, and for females 3,929. The rate in females has risen by 33.1% and males by 22.8% over the last 20 years.

Figure 1: rate of deaths from liver disease in persons, males and females aged under 75, England, 2001 to 2022 (directly standardised rate per 100,000 population aged under 75)

Premature mortality due to alcoholic liver disease

In 2022, there were 5,776 premature deaths from alcoholic liver disease in England. The rate in 2022 was not significantly different from the previous year:

• in 2022 the rate was 11.6 (11.3 to 11.9) per 100,000 population aged under 75
• in 2021 the rate was 11.5 (11.2 to 11.8) per 100,000 population aged under 75

Since 2003, the number of premature deaths from alcoholic liver disease has increased by 61.3% in England, rising by 53.7% in males and 76.9% in females.

Note: alcoholic liver disease is also known as alcohol-related liver disease.

Figure 2: number of deaths from alcoholic liver disease in persons aged under 75, England, 2001 to 2022

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

Figure 3: under 75 mortality rate from alcoholic liver disease, region, 2022 (directly standardised rate per 100,000 population aged under 75)

Across the county and UA, rates varied. South Tyneside had the highest rate at 24.4 (17.0 to 34.0) per 100,000 population aged under 75, this was 5 times higher than the lowest rate for Bromley at 4.9 (2.7 to 8.3) per 100,000 population. Lancashire had the highest number of premature deaths from alcoholic liver disease at 178.

Premature mortality due to non-alcoholic fatty liver disease (NAFLD)

Due to small numbers for premature mortality data, NAFLD is only available at England and regional level for both the 1-year and 3-year indicator.

In 2022, there were 323 deaths from NAFLD, a rate of 0.60 (0.60 to 0.70) per 100,000 population aged under 75. This rate has remained the same as for the previous 2 years.

Regional figures show the North West and the North East of England have the highest rates of premature death from NAFLD both with a rate of 1.30 per 100,000 population aged under 75.

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 over the last 20 years.

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

In 2022, the rate of hepatitis C related end stage liver disease or hepatocellular carcinoma mortality was 0.45 (0.39 to 0.51) per 100,000 population aged under 75.

Hospital admission rates due to liver disease

In the financial year ending 2023, there were 85,665 hospital admissions due to liver disease in England, a rate of 155.2 (152.9 to 157.5) per 100,000 population. 

The number of hospital admissions due to liver disease has increased by almost 51.5% compared to the financial year ending 2013, when there were 56,545 admissions. There has been a greater proportion increase in the number of females admitted than males in those 10 years.

Regionally the North East experiences the highest rates (205.7 (193.8 to 217.9) per 100,000 population) of hospital admissions due to the liver disease, however in terms of numbers, the South East has the highest number of residents admitted for liver disease with a count of 12,500.

Across the county and UA areas, there is a 4-fold difference between the rate of admissions for liver disease for the financial year ending 2023. Gateshead experienced the highest rates, 302.1 (239.4 to 368.6) per 100,000 population (605 admissions), while the lowest rate was in Wokingham, 71.5 (54.3 to 91.2) per 100,000 population (125 admissions).

Figure 4: rate of hospital admissions from liver disease in persons, males and females aged under 75, England, financial year ending 2011 to 2023 (directly standardised rate per 100,000 population)

Hospital admission rates for alcoholic liver disease

In the financial year ending 2023, there were 27,085 hospital admissions due to alcoholic liver disease in England, a rate of 49.4 (48.1 to 50.8) per 100,000 population.

The number of hospital admissions due to liver disease has increased by 67.7% compared to the financial year ending 2013, when there were 16,155 admissions. During that same time period, the number of males who had a hospital admission for alcoholic liver disease increased by 64.3%, and in females the admission rates increased by 74.8%.

Regionally, the North East experiences the highest rates (70.7 (64.4 to 77.3) per 100,000 population) of hospital admissions due to alcoholic liver disease, however the North East, at 1,860, has the lowest number of residents admitted for alcoholic liver disease compared with 4,380 in the North West region with the highest.

Hospital admission rates for non-alcoholic liver disease

In the financial year ending 2023, there were 3,126 hospital admissions due to NAFLD in England, a rate of 5.6 (5.3 to 5.9) per 100,000 population. This is significantly higher than the pre-pandemic rate in the financial year ending 2019 of 5.0 (4.8 to 5.2) per 100,000 population.

Methodology

Liver disease is defined in the profile as 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.

Inequalities data showing the difference in liver disease outcomes and care via deprivation decile is currently unavailable at the Lower layer Super Output Area (LSOA) level. Gradients are shown in the profile at a county and UA, and district and UA levels, where possible, but they show less variation due to the larger geographical areas smoothing out the smaller pockets of deprivation.

Revisions

The April 2024 update includes a full revision of the back series data where rates have been calculated using the rebased Office for National Statistics mid-year population estimates. Integrated care board (ICB) data has not been refreshed as we are awaiting the release of the ONS mid-year population estimates for LSOAs.

As part of the ongoing work in maintaining the live disease profile, indicators and methods are regularly reviewed. The hospital admissions indicator from NAFLD has now been calculated as a directly standardised rate. This change has allowed us to apply a revised methodology to obtain the confidence intervals that take into account non-independence of events. The Dobson and Byar method is applied with an adjusted variance that takes into account the actual number of people and the number of multiple admissions.

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 (JSNAs) 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 online version of the liver disease profile.

For queries relating to this document, please contact liverdisease@dhsc.gov.uk.