Britain has had the steepest increase in death rates from liver cirrhosis in western Europe since the 1950s, according to a study in this week's issue of The Lancet.

Rates of mortality due to liver cirrhosis can indicate the extent of alcohol harm occurring in a population. David Leon (London School of Hygiene and Tropical Medicine, UK) and Jim McCambridge (King's College London, UK) calculated the mortality rates for liver cirrhosis using data from the World Health Organization Mortality Database. They calculated rates for all ages and specific age groups in Scotland, England and Wales and compared these to rates in 12 other western European countries - Austria, Finland, Germany, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Sweden, and Denmark.

The investigators found that mortality rates for liver cirrhosis increased steeply in Scotland, England and Wales during the 1990s. Steady increases took place until the end of the 1970s, and accelerated in the 1980s and again from 1990 to 1994 onwards. In comparison, mortality rates for both men and women in the other European countries declined by 20-30% from the early 1970s. Between the periods 1987-1991, and 1997-2001, cirrhosis mortality in men in Scotland more than doubled, and in England and Wales it rose by over two-thirds. For women, rates increased by a half in the same period. Across both age-groups and sexes, the liver cirrhosis mortality rates in Scotland are now about double that of the European comparison group.

The authors blame increases in alcohol consumption, particularly wine and spirits, as the main reason for the rise in liver cirrhosis mortality. Total recorded alcohol consumption doubled between 1960 and 2002. They add that increases in the rates of heavy drinking, obesity, and hepatitis C may have also contributed. In western Europe, the reduction in mortality rates from liver cirrhosis has been driven by a decline in overall alcohol consumption in the mainly wine-drinking countries of Southern Europe, state the authors.

Professor Leon states: "Current alcohol policies in Britain should be assessed by the extent to which they can successfully halt the adverse trends in liver cirrhosis mortality. The situation in Scotland warrants particular attention."

In an accompanying comment Robin Room (Stockholm University, Sweden) states: "The UK used to be known to alcohol researchers for its relatively low rate of liver cirrhosis deaths. But Leon and McCambridge show that Great Britain has recorded the steepest rise in rates in western Europe…While beverage type, as mentioned in the paper, and pattern of drinking might both affect the risk of developing cirrhosis, there is no doubt that the cumulative amount of alcohol consumed has a primary role. But the UK Government has turned a determined blind eye to the problem and has failed to make the reduction of the population's alcohol intake a policy goal. Through the new alcohol licensing law and the official guidance on it, the national government has also done its best to tie the hands of local government on this issue."

Joe Santangelo
j.santangeloelsevier
Lancet
www.thelancet