Volume 386, Issue 10008, Pages (November 2015)

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Volume 386, Issue 10008, Pages 2098-2111 (November 2015) Implementation of the Lancet Standing Commission on Liver Disease in the UK  Prof Roger Williams, MD, Kathryn Ashton, MSc, Richard Aspinall, MBChB, Prof Mark A Bellis, DSc, Joanne Bosanquet, MSc, Prof Matthew E Cramp, MD, Natalie Day, MA, Prof Anil Dhawan, MD, Prof John Dillon, MD, Jessica Dyson, MBBS, James Ferguson, MD, Prof Graham Foster, FRCP, Prof Sir Ian Gilmore, MD, Michael Glynn, FRCP, J Ashley Guthrie, FRCR, Mark Hudson, FRCP, Prof Deirdre Kelly, MD, Andrew Langford, PhD, Prof Philip Newsome, PhD, Prof John O'Grady, MD, Rachel Pryke, MRCGP, Stephen Ryder, FRcP, Marianne Samyn, MD, Prof Nick Sheron, MD, Prof Julia Verne, PhD  The Lancet  Volume 386, Issue 10008, Pages 2098-2111 (November 2015) DOI: 10.1016/S0140-6736(15)00680-7 Copyright © 2015 Elsevier Ltd Terms and Conditions

Figure 1 Staffing and facilities for liver disease in 98 English hospitals returning data DGH=district general hospital. WTE=whole time equivalent. The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

Figure 2 Distribution of liver services in England in relation to directly standardised rates for liver disease hospital admissions in people of all ages, per 100 000 population, 2012–13 Map prepared under licence by Public Health England. © Crown copyright and database right 2015. Ordnance Survey 100016969. DGH=district general hospital. The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

Figure 3 Liver mortality in England and Wales, 1980–201326 Liver coding changed from International Classification of Diseases (ICD) 9 to ICD 10 between 2000 and 2001, leading to an increase in liver diagnoses. There has been little overall change in deaths from viral hepatitis or autoimmune or metabolic liver disease, and a steady but slight rise in deaths from non-alcoholic fatty liver disease (NAFLD and non-alcoholic steatohepatitis) due to obesity or diabetes. By far the greatest increase has been in deaths from alcohol-related liver disease. Discounting unknown causes the proportions of deaths are: alcohol 77%, NAFLD 8%, autoimmune or metabolic 5%, viral hepatitis 4%, miscellaneous known causes 7%. The Office for National Statistics (ONS) has historically attributed deaths of unrecorded cause to alcohol—if this were correct the proportion of alcohol-related deaths rises to 83%. Data were manually extracted from the ONS DH2 series, and ICD 9 codes converted into ICD 10 codes with standard mapping. Diagnostic codes were then further simplified. Details can be obtained from Prof Nick Sheron. The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

Figure 4 Licensed premises in the UK Numbers of licensed premises increased steadily up to the 1990s and have remained relatively stable since. New city centre “vertical drinking” pubs have opened, while many country pubs have closed. Data from Home Office, Scottish Government, Department for Social Development in Northern Ireland, and British Beer and Pub Association.27 There are no data for the period 2005–11; the final datapoint is for 2012. *British Beer & Pub Association estimate. The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

The Lancet 2015 386, 2098-2111DOI: (10.1016/S0140-6736(15)00680-7) Copyright © 2015 Elsevier Ltd Terms and Conditions

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