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

Abstract

Background & Aims: 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, and identify public health interventions that could impact on these risk factors to reduce the burden of liver disease. Methods: As part of the HEPAHEALTH project, commissioned by EASL, 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 WHO 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. Results: The epidemiology of liver disease is diverse and countries cluster with similar pictures, although the exact composition of diseases and the trends in risk factors which drive them is varied. 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 the majority of European countries. Interventions exist for curbing harmful alcohol use, reducing obesity, preventing or treating viral hepatitis, and screening for liver disease at an early stage. Conclusions: 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 prevalence and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease. Lay summary: The European region has seen dramatic increases in liver disease mortality and morbidity in recent decades as a result of changes in the underlying risk factors: excessive alcohol consumption, obesity and viral hepatitis. However, there are highly effective ways to combat these, for example increasing the price of alcohol, making it less readily available, reducing the number of calories, sugar and fat in foods we consume, or screening people earlier to treat them more effectively. The time is now for governments, the health system and individuals to implement the changes required to substantially reduce the burden of liver disease.

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ORCID for Nick Sheron: orcid.org/0000-0001-5232-8292

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