The past 30 years have witnessed major progress in the knowledge and management of liver disease, yet approximately 29 million people in the European Union still suffer from a chronic liver condition. Difficulties in accessing data from individual countries hinder global evaluation of liver disease in Europe. This report reviews 260 epidemiological studies published in the last five years to survey the current state of evidence on the burden of liver disease in Europe and its causes.

The four leading causes of cirrhosis and primary liver cancer in Europe are harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity. Chronic alcohol consumption is the main cause of cirrhosis in Europe. Alcohol consumption decreased in the 1990s, but has increased again in the last decade to stabilize at a high level of >9 litres of pure alcohol per year on average, although there are large variations among European countries.

According to WHO, liver cirrhosis accounted for 1.8% of all deaths in Europe (using WHO’s wide geographical definition), causing around 170,000 deaths per year. In the last decades of the 20th century, a very strong east-west gradient in mortality rates was observed, with the level of liver cirrhosis mortality in south-eastern Europe (especially in Hungary and Moldova but also in Slovakia, Slovenia and Romania) and in northeastern European countries achieving rates never before seen in Europe (figs. 1 and 2, see page 9 and 11). However, in recent years, liver cirrhosis has also become a serious health threat in some Western European countries, such as the United Kingdom and Ireland, where over the last 10 years the associated mortality has increased.