#FGDebate: addressing regional variations in care and outcomes for patients with liver disease

Liver disease is now the second highest cause of years of working life lost in Europe, only surpassed by ischaemic heart disease.1 The April #FGDebate based on the recent paper entitled ‘Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study’2 aimed to facilitate discussion around this topic. It highlighted a number of important themes; possible strategies to reduce disparities in care across the UK, challenges in hepatology training and supporting care delivery for patients with decompensated cirrhosis. In this article, we will expand on some of the key themes and discussions from this debate. ### Defining the issue Regional disparities in the provision of hepatology services and outcomes have been well-described historically3 as well as in multiple recent audits.2 4–6 Undoubtedly, this is partially explained by regional variation in social deprivation as well as public health policy including minimum unit pricing.7 However, access to specialist care and intervention has been repeatedly identified as a potential risk factor for adverse outcome. In the primary biliary cholangitis (PBC) study, patients in specialist centres were significantly more likely to be managed with appropriate second-line therapies and be referred for transplant assessment than those in non-specialist centres.6 Patients with metabolic-dysfunction-associated steatotic liver disease (MASLD) were more likely to have fibrosis assessment and comprehensive cardiometabolic assessment and management if they were managed in a centre with a multidisciplinary MASLD service.5 In patients presenting with decompensated cirrhosis, significant variations in mortality were seen between non-specialist centres which were not present in specialist centres.2 Additionally, lower consultant numbers corresponded to higher inpatient mortality in non-specialist centres, which was more likely to be the case in areas of higher social deprivation.2 There is also evidence from the USA and UK that …