Premature death from chronic liver disease is rising in England, largely as a result of lifestyle issues such as alcohol abuse, drug-taking and obesity.

The full extent of the problem is set out in the first ever NHS Atlas of Variation in Healthcare for People with Liver Disease, published today (March 26, 2013). It presents maps for 38 different issues relating to liver disesase, revealing widespread variations across the country in risk factors, services, expenditure and outcomes for patients and the wider population.

Evidence presented in the Atlas includes:

  • An 88% rise in age-standardised mortality from chronic liver disease, the only one of the major killers which is still increasing. There is significant variation in premature loss of life between areas, with deprivation a key factor.
  • The growing impact of alcohol misuse, estimated to cost the NHS £3.5bn a year. Almost one in four of all adults drink in a way that is potentially or actually harmful. Cirrhosis deaths are rising in England while falling in most other EU countries.
  • Major indications of alcohol abuse by children, with big local variations in the numbers admitted to hospital for alcohol-related problems.
  • Up to 20% of the population are potentially at risk of developing some liver damage.
  • Growing obesity in children is increasing the risk of serious liver disease in later life.
  • Hepatitis C is becoming more prevalent, with significant variations in estimated drug use which increases the risk of the disease.

Phil DaSilva, National Co-Director of Right Care, said: “We want this Atlas to build awareness and stimulate action to address unwarranted variation. This is not just an issue for the NHS and I’m pleased to have the positive engagement of charities in this. We encourage people with an interest in liver disease to take the opportunity the Atlas offers.”

Catherine Arkley, Chief Executive of Children’s Liver Disease Foundation, said: “We wholeheartedly welcome this Atlas. Whilst we recognise that there will always be some service variation depending on the demographics and prevalence of liver disease in an area, all patients should receive the same high quality of care, access to expertise, procedures and treatments. They should be assured of the same outcomes, regardless of where they live.”

Professor Martin Lombard, the National Clinical Director for Liver Disease, said: “Liver disease is a growing problem in this country.  Our perspective on cardiovascular and respiratory diseases – and the lifestyle choices that cause them – has changed in recent years, leading to declining mortality rates. But we are only at the beginning of that process for liver disease. We know we need joined-up action to improve awareness, prevention, detection and treatment, and this Atlas is a vital tool for all of us involved in the fight against liver disease.”

“The power of the Atlas lies not in the answers it provides, but in the questions it raises. More than anything else, we hope that patients, service providers, commissioners, monitors of public health and others will use the maps to ask questions in their own areas.”

The NHS Atlas of Variation in Healthcare for People with Liver Disease can be accessed online at, where an interactive version allows users to drill down to PCT level data. The Atlas is also available as PDF downloads.