P92 Geographic variation in the incidence of first emergency presentation of chronic liver disease by region and provision of liver disease assessment pathways in primary care

<h3>Introduction</h3> Chronic liver disease (CLD) in England is often first diagnosed following an emergency admission (EA) to hospital. Understanding regional variation in incidence of first EA (FEA) rates is required to target services for early detection of CLD to areas of greatest need. We report the incidence of FEAs for CLD across integrated care boards (ICBs) in England for 2018–2019, making comparison with the contemporaneous availability across ICBs of primary care liver assessment pathways, including transient elastography (TE) assessment. <h3>Methods</h3> We analysed Hospital Episodes Statistics (HES) records using ICD-10 diagnostic codes to identify patients who had a FEA to hospital between January 2018 and December 2019. Patients were excluded if they had an EA for CLD within the preceding 5 years. Each patient was mapped to an ICB according to their place of residence. ONS population data was used to calculate adult populations of each ICB according to age and sex for both years. We calculated age-sex (direct) standardised incidence rates of FEAs for CLD per 100,000 adults (18+) in each ICB. The provision of endorsed liver disease assessment pathways in primary care was determined by mapping 2020 survey data¹ to ICBs. <h3>Results</h3> Incidence rates of FEAs for CLD in 2018–2019 varied two-fold across ICBs from 21.1/100,000 population to 41.6/100,000 population (figure 1a). The 3 ICBs with highest incidence rates (41.6, 41.1, 39.8 FEAs for CLD/100,000 population) were in Northern England (2 in the North West, 1 in the North East and Yorkshire) while the 3 ICBs with lowest incidence rates (21.1, 21.2 and 21.7 EAs for CLD/100,000 population) were all in East of England. Availability of endorsed liver disease assessment pathways and TE in primary care varied across ICBs in 2020 (figure 1b). Four of the 10 ICBs in the lowest incidence quartile of FEA provided liver assessment pathways in primary care compared to 9 of 10 ICBs in the highest incidence quartile. Two of 10 ICBs in the lowest FEA incidence quartile provide TE in primary care compared to 6 of 10 ICBs in the highest incidence quartile. <h3>Conclusion</h3> There is marked geographic variation in incidence rates of FEA for CLD between ICBs, with evidence of marked North/South differences. Variation is also seen in provision of endorsed primary care liver disease assessment pathways, though this showed reasonable matching to areas of greatest need. <h3>Reference</h3> Helen Jarvis, Jonathan Worsfold, Vanessa Hebditch, Stephen Ryder. Engagement with community liver disease management across the UK: a cross-sectional survey. <i>BJGP Open</i>. 2021;<b>5</b>(5):BJGPO.2021.0085. DOI: 10.3399/BJGPO.2021.0085.