Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies

Abstract

The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, identifying public health interventions that could impact on these risk factors to reduce the burden of liver disease. As part of the HEPAHEALTH project we extracted information on historical and current prevalence and mortality from national and international literature and databases on liver disease in 35 countries in the World Health Organization European region, as well as historical and recent prevalence data on their main determinants; alcohol consumption, obesity and hepatitis B and C virus infections. We extracted information from peer-reviewed and grey literature to identify public health interventions targeting these risk factors. The epidemiology of liver disease is diverse, with variations in the exact composition of diseases and the trends in risk factors which drive them. Prevalence and mortality data indicate that increasing cirrhosis and liver cancer may be linked to dramatic increases in harmful alcohol consumption in Northern European countries, and viral hepatitis epidemics in Eastern and Southern European countries. Countries with historically low levels of liver disease may experience an increase in non-alcoholic fatty liver disease in the future, given the rise of obesity across most European countries. Liver disease in Europe is a serious issue, with increasing cirrhosis and liver cancer. The public health and hepatology communities are uniquely placed to implement measures aimed at reducing their causes: harmful alcohol consumption, child and adult obesity, and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease.

Changing trends in the disease burden of primary liver cancer caused by specific etiologies in China

“…The reduction in alcohol consumption observed since the 1970s in several countries across central Europe likely contributed to the decrease in liver cancer due to alcohol use incidence in that region . Therefore, policies intended to reduce alcohol consumption at the population level have the potential to substantially improve the health outcomes of populations, particularly young populations . NASH is a serious form of NAFLD, which can progress to advanced fibrosis, cirrhosis, and eventually hepatocellular carcinoma.…”

“…42 Therefore, policies intended to reduce alcohol consumption at the population level have the potential to substantially improve the health outcomes of populations, particularly young populations. 43 NASH is a serious form of NAFLD, which can progress to advanced fibrosis, cirrhosis, and eventually hepatocellular carcinoma. In China, NAFLD is a relatively new public health concern, and the current prevalence of NASH among liver biopsy-proven NAFLD patients is unknown.…”

Noninvasive diagnosis in alcohol‐related liver disease

“…Indeed, alcohol‐related liver disease (ALD) is a major cause of death worldwide . Although Europe has the highest levels of reported per capita alcohol consumption, there is heterogeneity between countries in terms of liver disease‐related death . This is mainly due to discrepancies between effective national public health policies and population level alcohol consumption .…”

“…Although Europe has the highest levels of reported per capita alcohol consumption, there is heterogeneity between countries in terms of liver disease‐related death . This is mainly due to discrepancies between effective national public health policies and population level alcohol consumption . Unfortunately, despite the fact that liver disease patients die at a younger age, little progress has been made in implementing comprehensive alcohol control strategies.…”

Liver Transplantation in France

“…Alcohol consumption has steadily declined in France during the last 3 decades, whereas it tended to increase in the United Kingdom. (5) However, alcohol-related liver diseases remain a leading indication for liver transplantation (LT), especially with the decline of HCV cirrhosis. Nonalcoholic steatohepatitis (NASH) is a growing indication for LT in France.…”