Liver Disease Burden in Tower Hamlets
Dr. Somen Banerjee, Director of Public Health in London Borough Tower Hamlets, highlights the concerning liver disease mortality rates in the area, with high incidence of cirrhosis, cancer, and hepatitis B and C. The data reveals a significant burden of liver diseases such as Non-Alcoholic Fatty Liver Disease and Alcoholic Liver Disease, surpassing London averages. The region faces challenges with hospital admissions linked to alcohol-related liver diseases and increasing trends in liver disease attributable to alcohol over the past years.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
Section 1: Introduction Dr Somen Banerjee, Director of Public Health London Borough Tower Hamlets
Liver disease mortality in Tower Hamlets nearly twice English average 26.6 16.2 14.7 Tower Hamlets London Average England average Http://hna.londonhp.nhs.uk/documents/PHOF/Tower%20Hamlets%20Regional%20PHOF.pdf This is Public Health Outcomes Framework baseline data (June 2012) showing the high mortality rate from liver disease for persons aged under 75 (per 100 000 population)
Liver disease in Tower Hamlets Area Tower Hamlets Performance Liver disease mortality in under 75 year olds One of highest in England Rate of admission for cirrhosis Highest in England Rate of primary liver cancer mortality in under 75 year olds Highest in England Incidence of acute hepatitis B Fifth highest in England Hospital admissions with chronic hepatitis B Highest in London Chronic hepatitis C prevalence rate Fourth highest in England Trend in hospital admissions for liver disease attributable to alcohol over past 5 years Increasing
Four causes of liver disease all result in cirrhosis, cancer & mortality Mortality Cirrhosis and Cancer Liver disease Non Alcoholic Fatty Liver Disease Alcoholic liver disease Hepatitis B Hepatitis C
Number of people in Tower Hamlets with each disease (GP diagnosis) 2546 765 647 458 Non-Alcoholic Fatty Liver Disease Hepatitis B Hepatitis C Alcoholic Liver Disease
The 4 diseases in Tower Hamlets, London and England Fifth highest incidence in England Highest prevalence in London Higher than London average for alcohol admissions Comparable data not available, but likely to be high Hepatitis B Hepatitis C Alcoholic Liver Disease Non-Alcoholic Fatty Liver Disease
Hepatitis B disease burden in Tower Hamlets 765 chronic hepatitis B cases Royal London: highest number of cases of chronic hepatitis B of any London hospital in 2011 (1,069 cases) Incidence of new, acute hepatitis B: 2.2 / 100,000 (2011) Fifth highest in London 7
Who gets Hep B in Tower Hamlets? Chronic cases detected and treated in Tower Hamlets are usually: People from south Asia Men Detected between ages 25-44 People who have acquired it during childhood in country of high prevalence (e.g. Bangladesh) New infections within Tower Hamlets are usually people who: Change sexual partners frequently, or Inject drugs, or Recently travelled to an area of high prevalence
Chronic Hepatitis C disease burden in Tower Hamlets 647 diagnosed cases However HPA estimates 1813 cases The fourth highest rate nationally So nearly two thirds undiagnosed We don t currently know the number of new cases each year Admissions increased from 12.7 to 19.3 per 100,000 from 2007-2012
Who gets Hep C in Tower Hamlets? Mostly men Predominantly report White ethnicity Usually diagnosed in adulthood Usually they are from one of the following at risk groups: Injecting drug users People who change sexual partners frequently Men who have sex with men
Alcoholic liver disease background 9000 high risk drinkers. 68% of migrants drink harmfully. 110 in-patient admissions for ALD in 2013/14 (total cost= 285,000) Prevalence of ALD= 458 15 deaths from ALD in 2012
3) Alcoholic liver disease TH hospital admissions between 2007-2012 increased from 31.6 to 54.6 per 100,000 population. 50 45 40 35 30 25 20 15 10 5 0 2007/08 2008/09 2009/10 2010/11 2011/12 Tower Hamlets rates of admissions to hospital for liver disease related to alcohol per 100,000 population 6% Majority of admissions due to alcoholic liver disease occur in the white population with only 6% occurring in Asian males and no recorded cases in Asian females. White males 29% White females Asian males 65%
Non alcoholic fatty liver disease (NAFLD) background Estimated prevalence in Tower Hamlets= 2546 Fat depositions in the liver potentially leading to cirrhosis and death Risk factors= obesity, diabetes Prevention and treatment= weight loss and exercise. High risk group= Bangladeshi 109 in-patient admissions in 2013/14 (total cost= 160,000)
Tackling liver disease - preventian and early intervention is key NHS Liver Care (2013) NHS Atlas of Variation in Healthcare for People with Liver Disease
Addressing Liver Disease A life course narrative Disease Early years Growing up Young Adults Middle age Older adults Screening mothers Child Vaccinations Hepatitis B Education on sexual health, alcohol and drugs Screening and vaccinating High quality services for people with liver disease Hepatitis C Screening mothers Sexual health, drug and alcohol services Early identification and prevention of harmful alcohol consumption and drug use Alcoholic Liver Disease Early identification and treatment of complications: Cirrhosis Liver Cancer Non-Alcoholic Fatty Liver Disease (NAFLD) Encourage physical activity and healthy eating Encourage physical activity and healthy eating Income, Housing, Environment, Social networks, Community, Health Behaviours, High Quality Services
Where we are now Health & Wellbeing Board have identified this as a priority area Completed needs assessment Mapped care pathways CCG appointed a clinical lead Stakeholder event July 14
Where we are now contd Primary care liver function testing has been unbundled this will save the CCG up to 300K in 3 years time. CEG clinical guidelines for the treatment of liver disease to be released September 2015 - for Tower Hamlets, Waltham Forest and Newham. A universal vaccination has been approved for Hepatitis B - NHSE are leading on this. The British liver Trust are having a love your liver event on the 26th of May. People will be able to have a fibroscan and increase their understanding of liver disease PLT Continue to explore issues in the secondary care pathway Launch of the liver disease page on the CCG intranet with all relevant information updated.
Summary Tower Hamlets has one of the highest levels of liver disease and mortality in the country The cost on secondary care is high Intervening early is more beneficial and can save money
