Deaths from Liver Disease: Implications for end of life care in England Professor Julia Verne

7.29 End of life Intelligence Network (PHOs, charities, researchers, key users) Raising profile Better understanding Better commissioning Research Improved measurement monitoring

Average number of deaths per year in England 2005–07, by sex and age group Women tend to die at an older age than men – 43% of female deaths are in the 85 and over age group compared with 24% of male deaths.

People are likely to be older at end of life

Place of death by age and sex, percentage of deaths in males and females in each age group in England 2005–07

Cause of death by place of death, percentage of deaths from each cause, England 2005–07

Main causes of death in England, Source: ONS Mortality Data

Trends in death from liver diseases in England, Source: ONS Mortality Data

Movements in mortality, England Source: ONS Mortality Data

Deaths (underlying cause) from liver disease types: number and proportion of all deaths in England, Source: ONS Mortality Data

Cause of death by Government Office Region: average annual number of deaths in England, Source: ONS Mortality Data

Cause of death by Government Office Region: Age Standardised Rate in Males, England Source: ONS Mortality Data

Cause of death by Government Office Region: Age Standardised Rate in Females, England Source: ONS Mortality Data

Cause of deaths (underlying cause) by sex: average annual number of liver disease deaths in males and females, England Source: ONS Mortality Data

Cause of deaths (underlying cause) by sex: proportion of liver disease deaths in males & females, England Source: ONS Mortality Data

Cause of deaths (underlying cause) by age: average annual number of liver disease deaths in each age group, England Source: ONS Mortality Data

Cause of deaths (underlying cause) by age: proportion of all deaths (by type) in each age group, England Source: ONS Mortality Data

Trends in death (underlying cause) from alcoholic liver disease: Number of death by age band, England Source: ONS Mortality Data

Deaths from alcoholic liver disease as a percentage of all liver disease deaths, England Source: ONS Mortality Data

Cause of death (underlying cause) by age and sex: average annual number of liver disease deaths in males and females in each age group, England Source: ONS Mortality Data

Cause of death (underlying cause) by age and sex: proportion of all deaths (by type) in males and females in each age group, England Source: ONS Mortality Data

Cause of death (underlying cause) by deprivation quintile: average annual number of liver disease deaths, England Source: ONS Mortality DataIMD: Index of Multiple Deprivation

Cause of death (underlying cause) by deprivation quintile: proportion of all liver disease deaths in each deprivation quintile, England Source: ONS Mortality DataIMD: Index of Multiple Deprivation

Cause of death as mentioned in any cause field (both underlying and contributory): average annual number of liver disease deaths, England Source: ONS Mortality Data

Cause of death as mentioned in any cause field (both underlying and contributory): liver disease deaths as a proportion of all deaths, England vs. 4% all deaths Source: ONS Mortality Data

Cause of death as mentioned in any cause field (both underlying and contributory): average annual number of liver disease deaths in males and females, England Source: ONS Mortality Data

Source: Office for National Statistics, annual mortality extracts Age and sex distribution of people who died with chronic renal failure recorded as either the underlying cause or a mention, England, 2001 to 2008

Source: Office for National Statistics, annual mortality extracts Age and sex distribution of people who died with renal carcinoma recorded as either the underlying cause or a mention, England, 2001 to 2008

Distribution of liver disease deaths by place of death, England Source: ONS Mortality Data

Place of death by underlying cause: average annual number of liver disease deaths, England Source: ONS Mortality Data

Distribution of liver disease deaths (underlying cause) by place of death for different age band, England Source: ONS Mortality Data

Distribution of age at death for each place of death: liver disease deaths (underlying cause), England Source: ONS Mortality Data

Distribution of place of death for each cause of death : liver disease deaths (underlying cause), England Source: ONS Mortality Data

Place of death for liver disease as underlying cause: proportion of liver disease deaths (place of death) by Government Office Region, England Source: ONS Mortality Data

Summary Liver disease accounts for 2% all deaths (underlying cause) 4% (mentions) and rising Accuracy of death certificates Alcoholic liver disease is the most common (> 1 in 10 deaths in year olds) Age, gender, socioeconomic and geographical variations >70% deaths in hospital Not yet captured how vulnerable this group is

Next Steps Explore characteristics of patients dying of liver disease further – other diagnoses More of place of death Patterns of hospital usage in last year of life

ONS HES NCPC Hospice Information Service Uptake of tools GSF, PPC, LCP Innovativ e practice QOF, EOL registers Surveys of public attitudes Complaints Marie Curie nursing uptake by PCTs Local Authorities* NCIN* Police* Funeral Directors * National audits Social care* Nursing & Care homes Coroners, Ministry of Justice Funding Prisons* Ambulance Trusts* A&E* Compendium of Data Sources