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

2. 7.29 End of life Intelligence Network (PHOs, charities, researchers, key users) Raising profile Better understanding Better commissioning Research Improved measurement monitoring

3. 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.

4. People are likely to be older at end of life

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

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

7. Main causes of death in England, 2001-2009 Source: ONS Mortality Data

8. Trends in death from liver diseases in England, 2001-2009 Source: ONS Mortality Data

9. Movements in mortality, England 2001-2009 Source: ONS Mortality Data

10. Deaths (underlying cause) from liver disease types: number and proportion of all deaths in England, 2001-2009 Source: ONS Mortality Data

11. Cause of death by Government Office Region: average annual number of deaths in England, 2001-2009 Source: ONS Mortality Data

12. Cause of death by Government Office Region: Age Standardised Rate in Males, England 2001-2009 Source: ONS Mortality Data

13. Cause of death by Government Office Region: Age Standardised Rate in Females, England 2001-2009 Source: ONS Mortality Data

14. Cause of deaths (underlying cause) by sex: average annual number of liver disease deaths in males and females, England 2001-2009 Source: ONS Mortality Data

15. Cause of deaths (underlying cause) by sex: proportion of liver disease deaths in males & females, England 2001-2009 Source: ONS Mortality Data

16. Cause of deaths (underlying cause) by age: average annual number of liver disease deaths in each age group, England 2001-2009 Source: ONS Mortality Data

17. Cause of deaths (underlying cause) by age: proportion of all deaths (by type) in each age group, England 2001-2009 Source: ONS Mortality Data

18. Trends in death (underlying cause) from alcoholic liver disease: Number of death by age band, England 2001- 2009 Source: ONS Mortality Data

19. Deaths from alcoholic liver disease as a percentage of all liver disease deaths, England 2001-2009 Source: ONS Mortality Data

20. 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 2001-2009 Source: ONS Mortality Data

21. Cause of death (underlying cause) by age and sex: proportion of all deaths (by type) in males and females in each age group, England 2001-2009 Source: ONS Mortality Data

22. Cause of death (underlying cause) by deprivation quintile: average annual number of liver disease deaths, England 2001-2009 Source: ONS Mortality DataIMD: Index of Multiple Deprivation

23. Cause of death (underlying cause) by deprivation quintile: proportion of all liver disease deaths in each deprivation quintile, England 2001-2009 Source: ONS Mortality DataIMD: Index of Multiple Deprivation

24. Cause of death as mentioned in any cause field (both underlying and contributory): average annual number of liver disease deaths, England 2001-2009 Source: ONS Mortality Data

25. Cause of death as mentioned in any cause field (both underlying and contributory): liver disease deaths as a proportion of all deaths, England 2001-2009 2 vs. 4% all deaths Source: ONS Mortality Data

26. 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 2001-2009 Source: ONS Mortality Data

27. 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

28. 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

29. Distribution of liver disease deaths by place of death, England 2001-2009 Source: ONS Mortality Data

30. Place of death by underlying cause: average annual number of liver disease deaths, England 2001-2009 Source: ONS Mortality Data

31. Distribution of liver disease deaths (underlying cause) by place of death for different age band, England 2001- 2009 Source: ONS Mortality Data

32. Distribution of age at death for each place of death: liver disease deaths (underlying cause), England 2001-2009 Source: ONS Mortality Data

33. Distribution of place of death for each cause of death : liver disease deaths (underlying cause), England 2001-2009 Source: ONS Mortality Data

34. Place of death for liver disease as underlying cause: proportion of liver disease deaths (place of death) by Government Office Region, England 2001-2009 Source: ONS Mortality Data

35. 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 40-49 year olds) Age, gender, socioeconomic and geographical variations >70% deaths in hospital Not yet captured how vulnerable this group is

36. 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

37. www.endoflifecare-intelligence.org.uk

39. 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

41. www.endoflifecare-intelligence.org.uk