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

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.