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Real Conversations: Liver Disease

27 June 2017

The latest in our series helping advisers tackle sensitive health subjects with clients reveals how a nation of social drinkers are affected by liver disease.

Bottles of wine

Liver disease is the only major cause of death still increasing year-on-year. Debra Hale explores the risk factors and how underwriters are responding.

Did you know that there are more than 100 forms of liver disease, it’s the fifth biggest killer in the UK and that it kills more people than diabetes and road deaths combined?
Even then, statistics about liver disease are understated, mainly because of the stigmatic assumptions of alcohol abuse, but also because the disease can cause multiple organ dysfunction which gets recorded as the cause of death rather than the liver disease itself.

However, liver disease is the only major cause of death still increasing year-on-year and whilst we tend to associate liver disease mainly with alcohol consumption, there are many other factors that contribute to the disease.

Risk factors

Some liver disease may be genetic. The disease can also be related to diet, smoking, alcohol consumption, drug-taking, medication, even salt intake – all factors that can affect liver function.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver problem in the western world affecting 20-30% of the population and most of it goes undiagnosed. This is a lifestyle-related condition linked primarily to type 2 diabetes and obesity.

Indeed, obesity is a contributing factor to other types of liver disease, such as hepatitis C and alcohol related liver disease.

Alcohol is a causal factor in more than 60 medical conditions, including mouth, throat, stomach, liver and breast cancers, high blood pressure, cirrhosis of the liver, fatty liver, depression, the list goes on.

Alcohol related liver disease (ARLD) accounted for nearly two-thirds of all alcohol-related deaths in 2014, according to the Office for National Statistics. It’s caused simply by drinking too much alcohol, so the more you drink above the recommended limits, the higher the risk of developing the disease.

Whether a binge drinker or regular drinker, there are health issues. Drinking a large amount in a short period of time can cause fatty liver disease, while regularly drinking above the recommended limits of alcohol over many years can cause hepatitis and cirrhosis – the more serious types of ARLD.

Cirrhosis results from permanent damage liver scarring so is the end stage of some forms of liver disease. It causes a number of other health problems, which is why so may die from the condition.

Take hepatocellular carcinoma (HCC) as an example. This cancer starts in the liver rather than a resulting secondary cancer. Cirrhosis is the main cause of HCC and the incidence rates of this cancer have been steadily rising in recent years.

Drinking culture

Liver disease infographic

Those who regularly drink over the recommended limit of 14 units a week are most at risk of developing ARLD. A unit of alcohol is 10mls of pure alcohol – a half pint of lager or 25mls of spirits. A small glass of wine is 125mls which is about 1.5 units of alcohol.

In a 2015 survey, 55% of men in England and 64% of women said their average weekly alcohol consumption was no more than 14 units, while 4% of men and 1% of women said it was more than 50 units. The rest of the sample fell somewhere between moderate and excessive.

Over 65s drink more frequently than any other group, but the young drink more units on a single occasion. In 2014, 48% of people aged 16-24 had drunk alcohol in the past week compared to 57% of those aged over 65, with the over 65s more likely to have drunk alcohol on five or more consecutive days.

Good news for our 11-15 year olds – they are drinking less and the figures are down one third in the past decade.

The male/female dynamic is interesting too, with men generally drinking more regularly than women, but one in four women over the age of 50 drinking more than six units in a day, and many choosing to skip meals and save their calories for alcohol.

Women are more vulnerable to the harmful effects of alcohol, but more men die from alcohol-related conditions.


Alcohol and underwriting

I find myself drawn to these facts and figures. My own social life is at times fairly reliant on alcohol, entertaining friends and family regularly with wine, cocktails and fruity ciders for the young ones (the over 18s of course).

My son, a 22-year-old with typical binge drinking behaviour, saves his drinking for a night out with his friends.

Many friends of a certain middle age enjoy a glass of wine or two each night with their dinner and my older friends and relatives regularly enjoy a gin and tonic or brandy as an evening ritual.

We are a nation of social drinkers and this has become more obvious in the last 30 years, so no wonder the upward shift in liver disease death rates in the 1990s – driven by factors such as pubs opening longer hours, supermarkets selling alcohol and even the rave culture. Alcohol is 60% more affordable now than it was in 1980 and all of this contributes to the ever rising mortality rates.

Alcohol is 10% of the UK’s burden of disease and death, and is the third biggest lifestyle risk factor after smoking and obesity, so naturally our underwriters ask questions about alcohol intake and lifestyle.

We look at current trends and consider our approach regularly so now ask much more specific questions about drinking habits. What do you drink? How often? How big is the glass? Have you been banned from driving? (Drink driving convictions or bans give a good indication of underlying alcohol issues.)

Support services

Thanks to growing risk factors and increasing incidence of liver disease, more clients have to undertake a liver function test when applying for protection.

Liver disease is silent and often deadly; when developed it has 25-50% immediate mortality. The average age of death from any liver disease is only 57 years, which for some of you will be your average aged client.

Life can be difficult at times and with certain demographics relative to your own client bank the risks of liver disease and in particular ARLD could be a real issue for many.

Zurich Support Service can help clients and their families who are struggling with the long or short-term effects of any illness and we have experienced clinical counsellors available to help with specific alcohol-related illnesses.

This facility can be overlooked when choosing providers, but it really adds a layer of client focused support and ultimately enhances your offering as a holistic protection adviser.

Debra Hale is a protection specialist at Zurich.