**Please note: Professor Nick Sheron retains the copyright to these slides. If you wish to use the content further, please email Nick.Sheron@soton.ac.uk for advice and guidance**
This presentation was delivered at Wessex AHSN's 2016 conference - Predict, Prevent, Adapt.
2. 0
20
40
60
80
100
120
%
Years
Percentage change in standardised UK mortality rates (age 0-64) normalised to
100% in 1970
circulatory
ischaemic heart
cerebrovascular
neoplasms
respiratory
endocrine /
metabolic
Data from WHO-HFA database downloaded Oct 2013
3. 0
100
200
300
400
500
600
%
Years
Percentage change in standardised UK mortality rates (age 0-64) normalised to 100% in 1970
circulatory
ischaemic heart
cerebrovascular
neoplasms
respiratory
liver
endocrine / metabolic
diabetes
Data from WHO-HFA database downloaded Oct 2013
5. Williams et al Lancet 2015
0100200300400500
1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010
%changesince1980
Trends in mortality from alcohol related liver disease in England and Wales , consumption of
spirits, wine, beer and cider, and changes in duty
Alcohol related liver deaths E&W %
White spirits consumption %
Whisky consumption %
Cider consumption %
Wine consumption %
Total lager / beer consumption alcohol %
Packaged strong lager %
6. Marketing theory - the four p’s
• Promotion
• Product
• Place of sale
• Price
7. Williams et al Lancet 2015
0100200300400500
1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010
%changesince1980
Trends in mortality from alcohol related liver disease in England and Wales , consumption of
spirits, wine, beer and cider, and changes in duty
Alcohol related liver deaths E&W %
White spirits consumption %
Whisky consumption %
Cider consumption %
Wine consumption %
Total lager / beer consumption alcohol %
Packaged strong lager %
8. 0
50
100
150
200
250
300
350
400
0
1
2
3
4
5
6
1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Thousandhectolitres
Units/week
Average consumption of alcopops and spirits by
10-15 year old schoolchildren in England,
overlay = total UK consumption of spirits
Children Spirits
Children Alcopops
Total UK white spirits
Total UK whisky
x 5
Sheron, Gilmore BMJ 2016 in press `
15. The Pareto Principle or 80:20 rule
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% of 18+ population % of alcohol units consumed
Extreme - over 75 units
Higher risk - 35/50 to 75
Increasing risk 14 to 35/50
Lower risk <=14 units
non-drinkers
17. Nick Sheron, unpublished analysis
Survival of admissions to the Liver Unit Southampton
1/3
1/3
1/3
18. 76%
P<0.001
Prior liver outpatient referrals in 5,112 Southampton first admissions with cirrhosis
Nick Sheron unpublished analysis
¾ of people who will
die of cirrhosis
currently have no idea
they have a liver
problem
19. The Southampton Liver Traffic Light Test
4,343 subjects followed for up to 12 years
SLTL n = 4,343
Mortality ROC = 0.83
Fibroscan n = 2,052
Complications C stat = 0.8
Mortality C stat = 0.67
ELF n = 457
Complications ROC = 0.87
20. 30% reduced drinking to safe levels
65% harmful / dependent drinkers
reduced to safe levels
Traffic light test in 400 heavy drinkers in primary care, follow up after one year
21. Check viral serology in all
patients
Simple liver
disease
Complex liver disease Acute complex liver disease
Risk factors Alcohol, obesity, virus. Immune, metabolic Viruses, immune, drugs
Red Reduce risk factors, refer or
check for varices
Refer hepatology Traffic light may not be much
use for acute disease, check
for viral hepatitis and drugs.
Refer ALL seronegative
hepatitis urgently
Amber Reduce risk factors, repeat
traffic light 3-5 years
Liver ultrasound, refer if U/S
normal
Green Reduce risk factors Review carefully, liver
ultrasound, repeat traffic
light early
22. Data prodrome
Data prodrome
Nurse intervention
Control
10 GPM practices randomised to intervention / control
= audit of GP Read Codes
24. LOCATE / ALLDeS teams
Miranda Kim
Magdy El-Gohari
Hazel Inskip
Colin Newell
Fangzhong Su
Emily Stimpson
Jo Dash
Tina Reinson
Jackie Hollis
Lucy Gruner
Maria Baggot
Natalie Stanton
Wendy O’Brien
Andrea Jarman
Mike Moore
Paul Roderick
Julia Sinclair
Maheswaran Naranjan
Topher Woelk
Richard Aspinall
Alan Knobel
Anonymised Hampshire Health Record Data:
HHRIGG
NHS SCW CSU