Liver disease referrals to an urban, hospital‐based hepatology outpatient clinic over the past 25 years

Abstract

Background Additional hepatologists are required to manage the rapidly increasing number of patients with liver disease. One disincentive to trainees considering a career in hepatology is the longstanding perception that outpatient hepatology consists largely of managing patients with alcohol‐induced liver disease (ALD). Objectives To document the types of liver diseases and changes in liver disease referrals to an urban outpatient liver disease clinic over the past 25 years. Methods The nature of the liver disorder, age, gender, and socioeconomic status of patients referred to an urban, hospital‐based, liver diseases outpatient program were documented from 1992 to 2017. Joinpoint analysis was performed to identify significant trends in referral prevalence rates of various disorders. Results In 1992/1993, hepatitis C virus (HCV), followed by hepatitis B virus (HBV), “other”, non‐alcoholic fatty liver disease (NAFLD), and primary biliary cholangitis (PBC) were the most common underlying liver diseases in referred patients (39, 36, 12, 4.5, and 3.5% respectively), whereas in 2016/2017, NAFLD, HBV, HCV, “other,” and ALD were most common (60, 15, 12, 8.7, and 3.3%, respectively). Aside from NAFLD referrals, which consistently increased over the 25‐year period, the prevalence of all other liver disease referrals fluctuated but generally declined. Recently referred patients were significantly older (38 ± 13 years in 1992/1993 and 49 ± 15 years in 2016/2017, P < 0.0001), while gender and socioeconomic status have not changed. Conclusions Hepatology is a diverse, dynamic subspecialty where ALD continues to constitute less than 5% of all patient referrals.

Metabolic primary liver cancer in adults: risk factors and pathogenic mechanisms

“…As a result of the combined effect of the decreasing burden of chronic viral hepatitis and the increasing NAFLD and NASH incidence [86][87][88][89][90] , NAFLD-HCC has overtaken viral hepatitis-HCC as the leading cause of HCC in many countries, particularly in the Western world [91] . The increasing epidemiological and clinical burden of NAFLD-HCC has impacted trends in liver transplantation [92] .…”

Molecular epidemiology and clinical characteristics of hepatitis D virus infection in Canada

“…It is plausible that access to universal healthcare may result in a relatively lower ratio of HBV referred patients having severe liver disease at the time of referral. The percentage of referred HBsAg-positive patients tested for HDV in Canada is speculative due to different systems capturing laboratory screening and reference testing results, but reports23 and personal communication (CanHepB Network members) in combination with reference laboratory data allows an estimate of the HDV testing prevalence. Towards the beginning of the decade (2012 J o u r n a l P r e -p r o o f onwards), approximately 4% to 25% of clinic HBV patient referrals were likely tested for HDV, with the rate increasing by the end of the decade (to 2019), to 50% of referrals on average being tested.…”