Implementing sustainable liver health in Europe: a second EASL-Lancet Commission

In December 2021, the European Association for the Study of the Liver (EASL)–Lancet Commission on liver disease in Europe launched its first report, which highlighted an alarming increase in liver-related mortality in many European countries. The Commission proposed a roadmap for addressing the documented negative trends. However, quoting one of the accompanying Comment articles, “gaining consensus on what needs to be done is perhaps the easiest step. Implementing change will be much harder, with many vested interests, both professional and commercial, to overcome.” This Commission aimed to evaluate and advance the enactment of the previously proposed recommendations.

We evaluated a range of evidence to update and refine the current burden and future projections of liver disease in Europe. This evidence included the 2023 update to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), a dedicated modelling framework developed by the Organisation for Economic Co-operation and Development (OECD), and data from both public (eg, UN and WHO) and modelling-based research databases (eg, Polaris Observatory). Cirrhosis and liver cancer cause almost 780 deaths per day in the WHO European Region, accounting for 3% of all deaths. Between 2000 and 2023, rates of liver cancer mortality have increased by more than 50%, and mortality from cirrhosis has remained persistently high. Liver disease burden has a pronounced negative effect on population-level health and life expectancy, and in the absence of liver diseases, the combined economies of the EU27 countries and Norway, Iceland, the UK, and Switzerland (otherwise known as the EU27+4) would be larger by an estimated €55 billion per year, highlighting the unsustainable economic and societal cost of inaction.

Liver disease encapsulates many of the challenges and opportunities that apply to a range of other chronic conditions, which share common risk factors and potential preventative solutions. Eliminating risk factors related to health behaviour (ie, lifestyle) alone would almost halve the burden of liver diseases in the EU27+4 and increase life expectancy. When accounting for the benefits of reducing alcohol consumption and excess weight on other major non-communicable diseases (such as cardiovascular diseases and type 2 diabetes), and cancers, average life expectancy would increase by 10·8 months (range 2·7 to 25·6 months across countries). Using GBD estimates for 2023, we show that three-quarters of the alcohol-attributable disability-adjusted life years lost in the WHO European region relate to non-liver-related causes such as other non-communicable diseases (47%), cancers (13%), and injuries (12%), reinforcing that addressing liver-related risk factors also results in broader health and longevity benefits to individuals and society.