Published online Jan 27, 2023. doi: 10.4254/wjh.v15.i1.89
Peer-review started: August 29, 2022
First decision: October 17, 2022
Revised: November 17, 2022
Accepted: December 31, 2022
Article in press: December 31, 2022
Published online: January 27, 2023
Processing time: 143 Days and 16.2 Hours
Liver disease incidence and hence demand on hepatology services is increasing.
To describe trends in incidence and natural history of liver diseases in Wales to inform effective provision of hepatology services.
The registry is populated by International Classification of Diseases-10 (ICD-10) code diagnoses for residents derived from mortality data and inpatient/day case activity between 1999-2019. Pseudo-anonymised linkage of: (1) Causative diag
The population of Wales in 2019 was 3.1 million. Between 1999 and 2019 73054 individuals were diagnosed with a hepatic disorder, including 18633 diagnosed with cirrhosis, 10965 with liver decompensation and 2316 with hepatocellular carcinoma (HCC). Over 21 years the incidence of liver diseases increased 3.6 fold, predominantly driven by a 10 fold increase in non-alcoholic fatty liver disease (NAFLD); the leading cause of liver disease from 2014. The incidence of cirrhosis, decompensation, HCC, and all-cause mortality tripled. Liver-related mortality doubled. Alcohol-related liver disease (ArLD), autoimmune liver disease and congestive hepatopathy were associated with the highest rates of decompensation and all-cause mortality.
A 10 fold increase in NAFLD incidence is driving a 3.6 fold increase in liver disease in Wales over 21 years. Liver-related morbidity and mortality rose more slowly reflecting the lower progression rate in NAFLD. Incidence of ArLD remained stable but was associated with the highest rates of liver-related and all-cause mortality.
Core Tip: In this paper we describe the following: (1) Novel methodology for developing a national liver registry; (2) The incidence of liver disease has increased 3.6-fold in Wales between 1999-2019 driven by a 10-fold increase in non-alcoholic fatty liver disease (NAFLD); (3) 3-fold increase in cirrhosis, portal hypertension, decompensation and hepatocellular carcinoma, 2-fold increase in liver disease related mortality between 1999-2019; and (4) Actuarial tables of 10-year liver disease progression: Alcohol-related liver disease, autoimmune liver disease and congestive hepatopathy are associated with increased rates of decompensation and death compared to viral hepatitis and NAFLD. Description of the proportion of patients dying from liver disease as directly, as a contributory cause or where liver disease has not been recording on the death certificate.