{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T02:25:23Z","timestamp":1771295123572,"version":"3.50.1"},"reference-count":44,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Liver Disease Implementation Group","award":["LDIG-22-19"],"award-info":[{"award-number":["LDIG-22-19"]}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["NIHR154876"],"award-info":[{"award-number":["NIHR154876"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,1,22]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To describe the incidence and key demographic, socioeconomic and clinical characteristics of individuals with liver disease in Wales.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and setting<\/jats:title>\n                  <jats:p>This study is designed as a retrospective observational study that linked data of anonymised identified individuals from primary, secondary care and mortality data from the Secure Anonymised Information Linkage (SAIL) Databank in Wales.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>All Welsh residents who registered with a SAIL-contributing general practitioner (GP) and diagnosed with liver disease from 2004 to 2022.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Our primary outcome is the annual age-standardised incidence rate of liver disease. Secondary outcome is the numbers and frequencies of underlying aetiology and the associated comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 2004 and 2022, 111 098 individuals received a diagnosis of liver disease in Wales and were included in this study. The incidence of liver disease increased 2.4 folds during the study period (110.3 per 100\u2009000 inhabitants in 2004 to 269.5 per 100\u2009000 inhabitants in 2022). A total of 79\u2009992 individuals (72%) entered the cohort with the underlying aetiology of liver disease, including alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD), viral hepatitis, metabolic, haemochromatosis and autoimmune liver diseases. NAFLD has contributed to most of the change in incidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We observed increasing incidence rates of liver disease in Wales, with NAFLD showing a particularly sharp increase and frequently identified as an underlying condition. A better understanding of the incidence of liver disease is the first step towards effective prevention, early detection and targeted intervention to improve patient outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-093335","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T08:50:35Z","timestamp":1739177435000},"page":"e093335","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Incidence rate and associated patient characteristics of liver disease in Wales 2004\u20132022: a retrospective population-scale observational study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7722-6177","authenticated-orcid":false,"given":"Jingwei","family":"Gao","sequence":"first","affiliation":[{"name":"Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0814-0801","authenticated-orcid":false,"given":"Ashley","family":"Akbari","sequence":"additional","affiliation":[{"name":"Population Data Science, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haroon","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aled","family":"Davies","sequence":"additional","affiliation":[{"name":"PRIME Centre Wales, Cardiff University, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Yeoman","sequence":"additional","affiliation":[{"name":"Aneurin Bevan University Health Board, Newport, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas Peter Ignatius","family":"Pembroke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, University Hospital of Wales, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"2025090907302124000_15.2.e093335.1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31173"},{"key":"2025090907302124000_15.2.e093335.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31012-1"},{"key":"2025090907302124000_15.2.e093335.3","unstructured":"Office for National Statistics . Deaths registered in england and wales (series dr): 2017. 2017. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsregisteredinenglandandwalesseriesdr\/2017 [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61838-9"},{"key":"2025090907302124000_15.2.e093335.5","doi-asserted-by":"crossref","DOI":"10.1186\/1741-7015-9-70","article-title":"The role of lifestyle changes in the management of chronic liver disease","volume":"9","author":"Nobili","year":"2011","journal-title":"BMC Med"},{"key":"2025090907302124000_15.2.e093335.6","unstructured":"Department of Health and Social Care . Advancing our health: prevention in the 2020s \u2013 consultation document. GOV.UK; 2019. Available: https:\/\/www.gov.uk\/government\/consultations\/advancing-our-health-prevention-in-the-2020s\/advancing-our-health-prevention-in-the-2020s-consultation-document [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.7","unstructured":"NICE . Diet, nutrition and obesity. Available: https:\/\/www.nice.org.uk\/guidance\/lifestyle-and-wellbeing\/diet--nutrition-and-obesity [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.8","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1016\/S0140-6736(16)32420-5","article-title":"A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective","volume":"389","author":"Burton","year":"2017","journal-title":"The Lancet"},{"key":"2025090907302124000_15.2.e093335.9","unstructured":"Welsh Government . The quality statement for liver disease: the quality statement describes what good quality liver disease services should look like. 2022. Available: https:\/\/www.gov.wales\/sites\/default\/files\/pdf-versions\/2023\/3\/1\/1679326108\/quality-statement-liver-disease.pdf [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.10","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1002\/pds.5216","article-title":"Health outcomes coding trends in the US Food and Drug Administration\u2019s Sentinel System during transition to International Classification of Diseases-10 coding system: A brief review","volume":"30","author":"Nam","year":"2021","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025090907302124000_15.2.e093335.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013752","article-title":"Liver cirrhosis in England-an observational study: are we measuring its burden occurrence correctly?","volume":"7","author":"Ratib","year":"2017","journal-title":"BMJ Open"},{"key":"2025090907302124000_15.2.e093335.12","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-9-157","article-title":"The SAIL Databank: building a national architecture for e-health research and evaluation","volume":"9","author":"Ford","year":"2009","journal-title":"BMC Health Serv Res"},{"key":"2025090907302124000_15.2.e093335.13","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6947-9-3","article-title":"The SAIL databank: linking multiple health and social care datasets","volume":"9","author":"Lyons","year":"2009","journal-title":"BMC Med Inform Decis Mak"},{"key":"2025090907302124000_15.2.e093335.14","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(16)32298-X","article-title":"The UK Secure eResearch Platform for public health research: a case study","volume":"388","author":"Jones","year":"2016","journal-title":"The Lancet"},{"key":"2025090907302124000_15.2.e093335.15","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2021-217090"},{"key":"2025090907302124000_15.2.e093335.16","article-title":"The Secure Anonymised Information Linkage databank Dementia e-cohort (SAIL-DeC)","volume":"5","author":"Schnier","year":"2020","journal-title":"Int J Popul Data Sci"},{"key":"2025090907302124000_15.2.e093335.17","unstructured":"Office for National Statistics . Population estimates for the uk, england, wales, scotland, and northern ireland: mid-2022. 2024. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/bulletins\/annualmidyearpopulationestimates\/mid2022 [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.18","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4254\/wjh.v15.i1.89","article-title":"Rising incidence, progression and changing patterns of liver disease in Wales 1999-2019","volume":"15","author":"Pembroke","year":"2023","journal-title":"World J Hepatol"},{"key":"2025090907302124000_15.2.e093335.19","unstructured":"Office for National Statistics . Estimate of the population for england and wales. 2023. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/datasets\/estimatesofthepopulationforenglandandwales [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0040296","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"4","author":"von Elm","year":"2007","journal-title":"PLoS Med"},{"key":"2025090907302124000_15.2.e093335.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PLoS Med"},{"key":"2025090907302124000_15.2.e093335.22","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s10654-023-01028-x","article-title":"Incidence, prevalence and mortality of chronic liver diseases in Sweden between 2005 and 2019","volume":"38","author":"Nasr","year":"2023","journal-title":"Eur J Epidemiol"},{"key":"2025090907302124000_15.2.e093335.23","doi-asserted-by":"crossref","first-page":"102068","DOI":"10.1016\/j.clinre.2022.102068","article-title":"Global burden of non-alcoholic fatty liver disease in 204 countries and territories from 1990 to 2019","volume":"47","author":"Tian","year":"2023","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"2025090907302124000_15.2.e093335.24","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1097\/CM9.0000000000002277","article-title":"Estimating global prevalence, incidence, and outcomes of non-alcoholic fatty liver disease from 2000 to 2021: systematic review and meta-analysis","volume":"135","author":"Liu","year":"2022","journal-title":"Chin Med J"},{"key":"2025090907302124000_15.2.e093335.25","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29546"},{"key":"2025090907302124000_15.2.e093335.26","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1177\/1403494818794814","article-title":"Morbid obesity in the UK: A modelling projection study to 2035","volume":"48","author":"Keaver","year":"2020","journal-title":"Scand J Public Health"},{"key":"2025090907302124000_15.2.e093335.27","unstructured":"Powell R . Diabetes prevalence \u2013 trends, risk factors, and 10-year projection. Public Health Wales; 2023. Available: https:\/\/phw.nhs.wales\/services-and-teams\/observatory\/data-and-analysis\/diabetes-prevalence-trends-risk-factors-and-10-year-projection [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.28","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2017.109"},{"key":"2025090907302124000_15.2.e093335.29","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1210\/jc.2015-3444","article-title":"Body Mass Index and Risk of Nonalcoholic Fatty Liver Disease: Two Electronic Health Record Prospective Studies","volume":"101","author":"Loomis","year":"2016","journal-title":"The Journal of Clinical Endocrinology & Metabolism"},{"key":"2025090907302124000_15.2.e093335.30","doi-asserted-by":"crossref","DOI":"10.1007\/s11892-021-01383-7","article-title":"The Relationship Between Type 2 Diabetes, NAFLD, and Cardiovascular Risk","volume":"21","author":"Caussy","year":"2021","journal-title":"Curr Diab Rep"},{"key":"2025090907302124000_15.2.e093335.31","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/3920196","article-title":"The Intricate Relationship between Type 2 Diabetes Mellitus (T2DM), Insulin Resistance (IR), and Nonalcoholic Fatty Liver Disease (NAFLD)","volume":"2020","author":"Tanase","year":"2020","journal-title":"J Diabetes Res"},{"key":"2025090907302124000_15.2.e093335.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.039"},{"key":"2025090907302124000_15.2.e093335.33","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.jhep.2022.10.010","article-title":"Time to focus on chronic liver diseases in the community: A review of primary care hepatology tools, pathways of care and reimbursement mechanisms","volume":"78","author":"Pryke","year":"2023","journal-title":"J Hepatol"},{"key":"2025090907302124000_15.2.e093335.34","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agv003"},{"key":"2025090907302124000_15.2.e093335.35","unstructured":"Office for National Statistics . Adult drinking habits in great britain: 2017. 2018. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/drugusealcoholandsmoking\/bulletins\/opinionsandlifestylesurveyadultdrinkinghabitsingreatbritain\/2017 [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.36","unstructured":"StatsWales . Adult lifestyles by year, 2016-17 to 2019-20. Available: https:\/\/statswales.gov.wales\/Catalogue\/National-Survey-for-Wales\/Population-Health\/Adult-Lifestyles\/adultlifestyles-by-year [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.37","unstructured":"Home Office . Alcohol strategy. GOV.UK; 2012. Available: https:\/\/www.gov.uk\/government\/publications\/alcohol-strategy [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.38","unstructured":"Welsh Health Circular . Attaining the who targets for eliminating hepatitis (b and c) as a significant threat to public health. welsh government. Welsh Government; 2017. Available: https:\/\/www.gov.wales\/sites\/default\/files\/publications\/2019-07\/attaining-the-who-targets-for-eliminating-hepatitis-b-and-c-as-a-significant-threat-to-public-health.pdf [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.39","unstructured":"Public Health Wales . Prevention, diagnosis and treatment of blood borne viruses in wales: hepatitis b, hepatitis c and hiv annual report 2023 (data to end 2022). 2023. Available: https:\/\/phw.nhs.wales\/publications\/publications1\/prevention-diagnosis-and-treatment-of-blood-borne-viruses-in-wales-hepatitis-b-hepatitis-c-and-hiv\/ [accessed 05 Jun 2024]"},{"key":"2025090907302124000_15.2.e093335.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-004275"},{"key":"2025090907302124000_15.2.e093335.41","unstructured":"Welsh Government . Together for health -liver disease delivery plan: a delivery plan for nhs wales and its partners to 2020. 2015. Available: https:\/\/www.gov.wales\/sites\/default\/files\/publications\/2018-12\/liver-disease-delivery-plan-2015-to-2020.pdf [Accessed 05 Jun 2024]."},{"key":"2025090907302124000_15.2.e093335.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.039"},{"key":"2025090907302124000_15.2.e093335.43","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200004273421707"},{"key":"2025090907302124000_15.2.e093335.44","unstructured":"Welsh Government . 2021-22 health board and public health wales nhs trust allocations. Cardiff Welsh Government; 2021. Available: https:\/\/www.gov.wales\/2021-22-health-board-and-public-health-wales-nhs-trust-allocations.pdf [accessed 05 Nov 2024]"}],"updated-by":[{"DOI":"10.1136\/bmjopen-2024-093335corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000}}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-093335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T14:32:26Z","timestamp":1757428346000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-093335"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,10]]},"published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1136\/bmjopen-2024-093335"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-093335","relation":{"correction":[{"id-type":"doi","id":"10.1136\/bmjopen-2024-093335corr1","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2]]}}}