Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease - PubMed (original) (raw)

doi: 10.1186/s12916-018-1103-x.

A Katrina Loomis 2, Jolyon Fairburn-Beech 1, Johan van der Lei 3, Talita Duarte-Salles 4, Daniel Prieto-Alhambra 5, David Ansell 6, Alessandro Pasqua 7, Francesco Lapi 7, Peter Rijnbeek 3, Mees Mosseveld 3, Paul Avillach 8, Peter Egger 1, Stuart Kendrick 1, Dawn M Waterworth 1, Naveed Sattar 9, William Alazawi 10

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Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease

Myriam Alexander et al. BMC Med. 2018.

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide. It affects an estimated 20% of the general population, based on cohort studies of varying size and heterogeneous selection. However, the prevalence and incidence of recorded NAFLD diagnoses in unselected real-world health-care records is unknown. We harmonised health records from four major European territories and assessed age- and sex-specific point prevalence and incidence of NAFLD over the past decade.

Methods: Data were extracted from The Health Improvement Network (UK), Health Search Database (Italy), Information System for Research in Primary Care (Spain) and Integrated Primary Care Information (Netherlands). Each database uses a different coding system. Prevalence and incidence estimates were pooled across databases by random-effects meta-analysis after a log-transformation.

Results: Data were available for 17,669,973 adults, of which 176,114 had a recorded diagnosis of NAFLD. Pooled prevalence trebled from 0.60% in 2007 (95% confidence interval: 0.41-0.79) to 1.85% (0.91-2.79) in 2014. Incidence doubled from 1.32 (0.83-1.82) to 2.35 (1.29-3.40) per 1000 person-years. The FIB-4 non-invasive estimate of liver fibrosis could be calculated in 40.6% of patients, of whom 29.6-35.7% had indeterminate or high-risk scores.

Conclusions: In the largest primary-care record study of its kind to date, rates of recorded NAFLD are much lower than expected suggesting under-diagnosis and under-recording. Despite this, we have identified rising incidence and prevalence of the diagnosis. Improved recognition of NAFLD may identify people who will benefit from risk factor modification or emerging therapies to prevent progression to cardiometabolic and hepatic complications.

Keywords: Epidemiology; NAFLD; NASH; Population.

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Conflict of interest statement

We followed local data laws in all four territories from which the data were obtained. In all countries, specific ethical approval was not required for this study as it used anonymised data. However, approval was sought and obtained from the scientific research committee for THIN, the IPCI Governing Board (reference 2015/18), the SIDIAP Ethics Committee (reference P15/167) and the scientific committee of the Italian College of General Practitioners and Primary Care.

Not applicable.

MA was contracted to work at, and JFB, PE, SK and DW are employees of, GlaxoSmithKline, which has conducted clinical research including trials of therapeutic agents in NAFLD. AKL is an employee of Pfizer, which is conducting clinical research including trials of therapeutic agents in NAFLD. DPA has received unrestricted research grants from UCB, Amgen and Servier, and consultancy fees (paid to his department or research group) from UCB Pharma. DA has provided consultancy and advice to many pharmaceutical companies on undertaking outcome studies using real-world evidence. FL has provided consultancy tor AlfaSigma, Bayer and Abbvie. PE and SK are employees and stockholders of GlaxoSmithKline. NS has consulted for Boehringer Ingelheim, Eli Lilly, Novo Nordisk and Janssen, and has received grants from Astrazeneca and BI. WA is a consultant and has delivered sponsored lectures to UCB Pharma, Gilead, Intercept and Medimmune. TDS has no conflicts of interest to declare.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Fig. 1

Point prevalence of NAFLD (per 100 persons) by calendar year. Results are shown for each database and pooled across databases by meta-analysis. The pooled estimate is provided from 2007 only as data from SIDIAP were available only from that year onward. The pooled estimate confidence interval is shaded grey. HSD Health Search Database, IPCI Integrated Primary Care Information, NAFLD non-alcoholic fatty liver disease, SIDIAP Information System for Research in Primary Care, THIN The Health Improvement Network

Fig. 2

Fig. 2

Point prevalence of NAFLD (per 100 persons) by age group on 1 January 2015 in a males and b females. HSD Health Search Database, IPCI Integrated Primary Care Information, NAFLD non-alcoholic fatty liver disease, SIDIAP Information System for Research in Primary Care, THIN The Health Improvement Network

Fig. 3

Fig. 3

Incidence of NAFLD (per 1000 person-years) by calendar year in four primary-care databases, and pooled across databases by a random effects meta-analysis. The pooled estimate is provided from 2007 only as data from SIDIAP were available only from that year onward. The pooled estimate confidence interval is shaded grey. HSD Health Search Database, IPCI Integrated Primary Care Information, NAFLD non-alcoholic fatty liver disease, SIDIAP Information System for Research in Primary Care, THIN The Health Improvement Network

Fig. 4

Fig. 4

Incidence of NAFLD (per 1000 person-years) by age group for the four primary care databases for 2015 in a males and b females. HSD Health Search Database, IPCI Integrated Primary Care Information, NAFLD non-alcoholic fatty liver disease, SIDIAP Information System for Research in Primary Care, THIN The Health Improvement Network

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