changing the paradigm for liver disease - nick sheron
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19701972
19741976
19781980
19821984
19861988
19901992
19941996
19982000
20022004
20062008
20100
20
40
60
80
100
120Percentage change in standardised UK mortality rates (age 0-64) normalised to 100% in 1970
circulatoryischaemic heartcerebrovascularneoplasmsrespiratoryendocrine / metabolicdiabetes
Years
%
Data from WHO-HFA database downloaded Oct 2013
19701972
19741976
19781980
19821984
19861988
19901992
19941996
19982000
20022004
20062008
20100
100
200
300
400
500
600Percentage change in standardised UK mortality rates (age 0-64) normalised to 100% in 1970
circulatoryischaemic heartcerebrovascularneoplasmsrespiratoryliverendocrine / metabolicdiabetes
Years
%
Data from WHO-HFA database downloaded Oct 2013
Williams et al Lancet 2015
050
100
150
200
250
300
350
400
450
500
Trends in mortality from alcohol related liver disease in England and Wales , con-sumption of spirits, wine, beer and cider, and changes in duty
Alcohol related liver deaths E&W %
White spirits consumption %
Whisky con-sumption %
Cider consumption %
Wine consumption %
Total lager / beer consumption al-cohol %
Packaged strong lager %
% c
hang
e sin
ce 1
980
76%
P<0.001
Prior liver outpatient referrals in 5,112 Southampton first admissions with cirrhosis
Nick Sheron unpublished analysis
¾ of people who will die of cirrhosis have no idea they are ill
Necrosis = cell swells, membrane leaks,enzymes escape
Liver enzymes are raised in blood
Viral hepatitis
Autoimmune hepatitis
30% reduced drinking to safe levels
65% reduced drinking to safe levels
Traffic light test given to 400 heavy drinkers in primary care
follow up data at one year
Emma Greatorex, Katie Minards, David Cable, Alan Hales
Biochemistry data
Haematology data
Endoscopy data
PAS data
Pathology data
Hampshire Health Record data
Acknowledgments:
POLeMMICColin NewellMagdy El-GohariEmily StimpsonJo DashTina ReinsonJackie HollisLucy GrunerMaria BaggotNatalie StantonWendy O’BrienAndrea JarmanMike MoorePaul RoderickJulia SinclairMiranda KimMaheswaran NaranjanTopher Woelk
Data:HHRIGGNHS SCW CSU
Funding:
British Liver TrustNIHR BRC