Abstract
THE RISK OF LIVER FIBROSIS IS GREATEST IN AREAS OF HIGHER SOCIOECONOMIC DEPRIVATION: A RISK-FACTOR BASED POPULATION SCREENING STUDY.
Background:
Early detection of liver disease has been identified as a public health priority in the UK. Symptoms are rare before advanced stages and case finding using risk factors improves identification. In financially constrained health systems, case finding in areas with greater disease burden is prudent. Socio-economic deprivation is associated with advanced liver disease. We assessed the incidence of liver disease by population deprivation using a community case finding pathway.
Methods:
6 primary care practices (PCP) were selected from different socio-economic areas of Manchester, UK. A mean Index of Multiple Deprivation (IMD) score was calculated for each PCP based on its catchment area. PCPs were grouped into low (n=3), medium (n=1) and high deprivation (n=2). Patients were identified using SNOMED codes for risk factors, including Type 2 diabetes, Body Mass Index >30kg/m2, harmful alcohol consumption (>280/>400 grams ethanol in females/males per week), abnormal ALT or hepatic steatosis. Patients with ≥2 risk factors were invited to a one stop community assessment. A sub-group of patients with 1 risk factor were invited depending on capacity. Patients underwent a clinical history, full liver blood based aetiological screen and transient elastography (TE). Fibrosis was assessed with FIB-4 score and TE. Fibrosis risk was determined by a liver stiffness measurement (LSM) >8.0kPa and FIB-4 >1.30.
Results:
A total population of 63,143 patients were investigated, of which 7813 (12.4%) had ≥1 risk factor. 5839 (74.7%) and 1974 (25.3%) patients had 1 and ≥2 risk factors respectively. 1907 (1557x ≥2 risk factors, 350x 1 risk factor) patients were invited for assessment of which 430 (22.5%) patients attended. 300 (69.8%) patients were diagnosed with NAFLD. 38 (8.8%) patients were identified with alcohol related liver disease and 53 (12.3%) patients had mixed alcohol and metabolic disease. 59 (13.7%) patients had a LSM >8.0 kPa. More patients from areas of high deprivation (26 (21.9%) patients) had risk of liver fibrosis compared to areas of medium (14/89 (15.7%) patients) and low deprivation (21/222 (9.5%) patients) (X2 (2, N=430)= 9.99, p = 0.0068)(Figure 1). Adjusting for age and gender, patients from areas of high deprivation were significantly more likely to have fibrosis risk than those from areas of low deprivation (adjusted OR 1.02, p = 0.012, 95% CI 1.004-1.035).
Conclusion:
Proactive community-based case finding for liver disease is best targeted in areas of high deprivation to improve diagnostic yields.