Mortality rates due to cirrhosis and other liver diseases are known to have increased slowly between the 1970s and the early 1990s in the United Kingdom, with the poor prognosis associated with advanced liver failure meaning that its prevalence may be reflected by mortality statistics.
Using this fact, researchers from health centers in the West Midlands region of the UK examined public health mortality files, supplied by the Office for National Statistics, to ascertain the current mortality rates from liver disease in that part of the country.
The study was set in three adjacent metropolitan boroughs in the West Midlands with a total population of 837,000.
Approximately 8.4% of the study population were of south Asian origin (Indian, Pakistani, or Bangladeshi).
The research team identified deaths from liver disease by searching the public health mortality records using ICD-9 (International Classification of Diseases, 9th revision) reference codes 570-573.
South Asian origin and religion were identified from subjects' names.
In incidences of deaths from liver disease of unspecified cause, the case notes of the subject were analyzed to identify underlying causative factors.
Crude mortality from primary liver disease was found to have increased from 6.0 per 100,000 population in 1993, to 12.7 per 100,000 population in 2000.
During the same period, rates of alcoholic liver disease increased nearly 3-fold (2.8 deaths/100,000 in 1993 versus 8.0 deaths/100,000 in 2000).
This 3-fold rise in mortality due to alcoholic liver disease could almost exclusively account for the overall rise in crude mortality, even though there was some stabilization in alcoholic liver disease-related deaths from 1998 onwards.
Rates of increase in deaths from alcoholic liver disease were similar for white men, white women, and Asian men.
Asian men had a standardized mortality ratio 3.79 times (3.21 to 4.26) that of white men (based on 46 observed deaths compared with 12.4 expected by extrapolation from the white male population).
80% of the Asian men were judged to be of Sikh religion.
After alcoholic liver disease, the largest cause of death was "unspecified" liver disease, with an annual incidence of 2.5/100 000 population.
Alcohol misuse was the presumed cause in 67% (44) of 66 such cases as judged by analysis of case notes. Annual mortality from other defined liver diseases was about 0.5/100 000.
Commenting on the findings of the survey, the authors say that although the rise in deaths from alcoholic liver disease might be the result of increasing alcohol consumption, available evidence does not show an increase in the total national alcohol consumption in the past decade.
| There was a 3-fold rise in alcoholic liver disease-related deaths between 1993 and 2000|
|British Medical Journal|
There is also no data to suggest that the numbers of people drinking heavily has risen over the past 10 years.
They suggest that the type of alcoholic drink being consumed and dietary or other factors, such as genetic or unidentified environmental factors, may therefore be implicated.
The authors add that the increasing prevalence of alcoholic liver disease among Asians may also be contributing, saying that although the overall population of Asians in the study was small, their excess risk of mortality is worth further study.
These data have important implications for public health and hospital physicians. The halting or reversal of the trend in deaths from alcoholic liver disease that we have described requires further public emphasis on the risk of fatal liver disease from excessive alcohol consumption, they conclude.