Community Level Liver Disease Prevention

Chronic liver disease is a major cause of morbidity and mortality both worldwide and in the United States (U.S.). Mortality due to liver cirrhosis has increased over the last 20 years in the U.S. and have persisted despite epidemiologic shifts in the underlying causes of liver disease. Furthermore, chronic liver disease has a substantial impact on young and middle-aged individuals in their prime, with more than half of deaths attributable to chronic liver disease occurring before age 65. The cost of liver disease in the U.S. is estimated to reach $32.5 billion per year in 2026. For these reasons, reducing deaths due to liver cirrhosis is one of the goals of Healthy People 2030. Trends in Connecticut have followed the national pattern.

The major risk factors for liver disease are viral hepatitis (HBV, HCV, HDV, HEV), hazardous alcohol use, metabolic disease. In most cases, progression of chronic liver disease can be prevented. Chronic liver disease can be approached with the typical prevention framework: primary prevention to mitigate the above-mentioned risk factors and avoid development of chronic liver disease; secondary prevention in patients with established liver disease to prevent its progression toward cirrhosis or liver cancer; and tertiary prevention to ameliorate the negative consequences of cirrhosis, for example, screening for liver cancer and treating portal hypertension.

Unfortunately, most of the care currently provided to patients with chronic liver disease occurs in the final stages of illness: decompensated cirrhosis and liver cancer. Thus, most of our activity focuses on conditions that represent the failure of all three stages of prevention. We aim to reverse this trend and believe that preventative measures can be implemented through collaboration with health service providers and communities.

We propose this collaborative event to begin a dialogue about community-level prevention of chronic liver disease between Yale Liver Center members and physicians, community physicians and the Department of Public Health (DPH). The overarching goal is to marry the expertise in liver disease and novel paradigms in liver disease prevention and detection with the public health messaging and implementation expertise of the DPH to improve prevention, diagnosis, and management of chronic liver disease in Connecticut.