Epidemiological comparison of cirrhosis to other long-term health conditions in the United Kingdom.

Abstract

Background: Although cirrhosis is a serious long-term health condition (LTC), it tends to receive little attention from healthcare policymakers. Here, we sought to describe how cirrhosis compares to other LTCs to inform priority-setting discussions.

Methods: We analysed data from the Our Future Health (OFH) study, a cohort of ∼1.7 million individuals from England, United Kingdom. Self-reported diagnosis status for cirrhosis and 15 benchmark LTCs (including type 1 diabetes, type 2 diabetes, Parkinson's disease, chronic kidney disease, schizophrenia, and stage 4 cancer) were ascertained from the enrolment questionnaire. Each LTC was profiled with respect to: sociodemographic characteristics; mortality; comorbidity burden; and late diagnosis. Furthermore, information on each LTC's trajectory (i.e., increasing, stable, or decreasing over time) was determined from background mortality data over the last decade.

Results: The study cohort included 1,613,777 participants, of whom 2,606 (0.2%) reported a diagnosis of cirrhosis. Mortality elevation for participants with cirrhosis versus without was substantial (HR: 7.46; P<0.001, with adjustment for age/sex) and comparable to dementia (HR:7.60), stage 4 cancer (HR:7.06), whilst higher than schizophrenia (HR:4.46) and heart failure (HR:4.01). People with cirrhosis had more co-existing health conditions/diseases than other LTCs (i.e., elevated prevalence for 58/145 distinct health conditions; second only to stage 4 cancer). Area-based deprivation score was third highest for cirrhosis, behind COPD and schizophrenia. Late diagnosis of cirrhosis was commonplace, with <15% of new-onset liver failure reporting cirrhosis at enrolment. Cirrhosis also exhibited an upward trajectory, with mortality increasing by ∼20% in the last decade.

Conclusion: Cirrhosis is an anomaly LTC with respect to its deprivation, comorbidity, mortality, upward trajectory, and late diagnosis profile. Our data provide comparative evidence to inform priority-setting discussions with policymakers.

Impact and implications: Various levers are available to policy makers for reducing incidence of liver cirrhosis. However, other health conditions are often prioritised by policy makers ahead of cirrhosis; the decision-making process around this is not always transparent nor grounded in evidence. This study explores the characteristics of cirrhosis relative to other long-term conditions through a public-health lens. Our findings may guide priority-setting discussions between policy makers, advocates and other stakeholders and may shift current discourse onto a more empirical footing.