Following our successful piece on HIV in Sex Workers, the Lancet asked us to produce an infographic to summarise the findings of the UK Commission on Liver Disease.
Producer: Aimée Stewart • Designers: Paulo Estriga & Caroline Leprovost for Graphic Digital Agency
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Lancet liver disease infographic
1. The UK population changed their drinking habits
reflecting the affordability of stronger alcohol
at home…
…and the number of people admitted to hospital
for alcohol-related liver disease has almost doubled
in a decade.
UK LIVER
DISEASE CRISIS
Survival rates have improved for almost every disease of every organ in the last
few decades, with one notable exception: liver disease1
.
What’s driving this?
Annual deaths related to hepatitis C have
quadrupled since 1996. It is estimated that
around 75% of infected cases are unknown4
.
Introduce a minimum price of 50p to reduce alcohol consumption.
reduction
in obesity
rate for
women
reduction
in obesity
rate for
men
20%TAX
on soft drinks
3.8% 2.4%
Identify the15-20% of NAFLD*
cases likely to progress to
severe liver disease when
screening for other
obesity-related diseases.
Increase medical provision
with more specialists and
liver clinics distributed
across the UK.
Vaccinate at-risk populations
for Hepatitis B and target use
of antiretrovirals for people
with hepatitis B and C
PROJECTED MINIMUM PRICE PER UNIT OF ALCOHOL AND RESULTING PERCENTAGE DECREASE IN CONSUMPTION5
50p
5p
10p
20p
5p
20p20p
10p
20p
20p
20p
5p
20p
20p
10p
50p
20p
50p
0% -0.1% -0.4% -1.1%
-2.4%
-4.3%
-6.7%
-11.9%
-17.5%
What have the UK’s European neighbours done?
So what changes do we need to make in the UK?
A steady fall in cirrhosis deaths in France over
the last 30 years corresponds to a proportionate
fall in alcohol consumption over the period7
.
Conversely, a 33% reduction in Finnish
alcohol taxation in 2004 resulted in soaring
rates of liver disease8
.
Introduce a tax on soft drinks to reduce sugar intake9
.
POLICY MAKERS
MEDICAL CARE
Of the 25% of the UK population with
obesity, a vast majority has non-alcohol
related fatty liver disease1
.
2 3
1
France and Italy have seen a dramatic reduction in liver mortality whereas the UK and Finland
have seen liver deaths rise more than fivefold1
.
PERCENTAGE CHANGE IN STANDARDISED UK MORTALITY RATES (AGE 0–64) NORMALISED TO 100% IN 19701
0%
20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970
300%
600%
BLOOD DIABETES CANCERENDOCRINE /
METABOLIC
HEART
DISEASE
RESPIRATORY CIRCULATORY STROKE
ALL ITEMS
BEER OFF SALES*WINE & SPIRITS OFF SALES*
WINE & SPIRITS ON SALES*BEER ON SALES*
1987 1990 1995 2000 2005 2010 2013
350
100
150
200
250
300
PRICE OF BEER, WINE & SPIRITS VERSUS INFLATION2
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
50,000
Admissions
Admissions
Deaths per 100,000
Number of deaths
Hours worked
*NAFLD = non alcoholic fatty liver disease
Price re-based to 100
* On-sales means in pubs and restaurants, off-sales means liquor stores and supermarkets.
40,000
30,000
20,000
25,000
35,000
45,000
ALCOHOL-RELATED HOSPITAL ADMISSIONS3
HOSPITAL ADMISSIONS FOR NON-ALCOHOL
RELATED FATTY LIVER DISEASE1
DEATHS FROM LIVER FAILURE OR LIVER CANCER
IN THOSE WITH HEPATITIS C6
20,000
10,000
0
5,000
15,000
500
300
0
200
100
400
1998 2000 2005 2010 20122010200520001996
PERCENTANGE CHANGE IN STANDARDISED DEATH RATES1
40
35
30
25
20
15
10
5
0
UNITED KINGDOM ITALY NETHERLANDSSWEDEN NORWAYIRELANDFRANCE FINLAND
20101970 1975 1985 20051980 1990 1995 2000
Additionally, people in France diagnosed with
hepatitis C are 6–12 times more likely to receive
treatment than those diagnosed in the UK.4
HOURS AN INDUSTRY WORKER HAS TO WORK TO
AFFORD HALF A LITRE OF VODKA IN FINLAND8
TOTAL WINE CONSUMPTION IN FRANCE,
NORMALISED TO 100% IN 20007
2
1.5
1
0.5
0
1965 1970 1980 1990 2008
1990 1995 2000 2005 2009
250%
150%
0%
100%
50%
200%
2000
For further information on the recommendations of the Commission or to read the full report, visit
http://www.thelancet.com/commissions/crisis-of-liver-disease-in-the-UK
SOURCES
1
Williams R, Aspinall R, Bellis M, et al. Addressing liver disease in the UK: a
blueprint for attaining excellence in healthcare for liver disease and reducing
premature mortality from the major lifestyle issue of excess alcohol
consumption, obesity, and viral hepatitis. Lancet 2014; published online Nov 27,
2014. http://dx/doi.org/10.1016/S0140-6736(14)61838-9
2
ONS. Retail price index: all items versus beer, wine, and spirits, on and off
sales. 1987–2014. Newport; Office for National Statistics, 2014.
http://www.ons.gov.uk/ons/datasets-and-tables/data-selector.html?table-id=2.1
&dataset=mm23
3
HSCIC. Statistics on alcohol: England, 2014. Leeds; Health and Social Care
Information Centre, 2014.
4
The Hepatitis C Trust. The UK vs Europe: losing the fight against hepatitis C,
2005. London; The Hepatitis C Trust and the University of Southampton, 2005.
5
British Medical Association. Reducing the affordability of alcohol: a briefing
from the BMA Board of Science. London; British Medical Association, 2012.
6
Constella A, Goldberg D, Harris H, et al and Public Health England. Hepatitis C
in the UK: 2014 report. London; Public Health England, revised July 31, 2014.
7
Jewell J, Sheron N. 2010. Trends in European liver death rates: implications
for alcohol policy. Clin Med 2010; 10: 259–63.
8
Karlsson T, Mäkelä P, Österberg E, Tigerstedt C. A new alcohol environment.
Trends in alcohol consumption, harms and policy: Finland 1990–2010. Nord
Stud Alcohol Dr 2013; 27: 497–513.
9
Manyema M, Veerman LJ, Chola L. The potential impact of a 20% tax on
sugar-sweetened beverages on obesity in South African adults: a mathematical
model. PLoS One 2014; 9: e105287.
LIVER
20101970