Liver Disease in Canada
Based on available data, researchers estimate that about 1 in 10 Canadians have some form of liver disease – that’s more than 3 million people – although even this may be an underestimate. The Canadian Liver Foundation (CLF) released a detailed analysis in 2013 outlining the emerging crisis in this health area.1 The report’s authors suggest that the persistent stigma surrounding liver disease likely contributes to the challenges we face in increasing public awareness, and providing the voice necessary to raise further research funds through charitable donations and from government bodies.
In a concerning report by the Canadian Cancer Society (CCS),2 researchers say that liver cancer is also on an alarming rise. Since the 1970s, the incidence of liver cancer in Canada has tripled in men and doubled in women. A staggering 4 out of 5 individuals with liver cancer (80%) will die within 5 years of diagnosis.
Viral Hepatitis More Dangerous Than HIV?
Researchers do not know exactly how many Canadians are affected by viral hepatitis, but they estimate that approximately 500,000 have chronic hepatitis B or C. Many who have these illnesses do not become aware of it until severe liver damage has occurred, causing noticeable symptoms, such as fatigue, discomfort in the abdomen, fluid accumulation in the abdomen (ascites), bleeding from veins in the esophagus or stomach (varices), or confusion (encephalopathy). The risks for those with chronic viral hepatitis include cirrhosis, liver failure, and liver cancer.
Due to dedicated awareness initiatives started in the 1980s, most people understand that human immunodeficiency virus (HIV) infection is a serious, life-threatening disease, but they might not be aware that hepatitis is much more common than HIV infection and the rate of death from chronic hepatitis C, for instance, is much higher. Funding from various federal government departments/agencies is 10 times more for HIV research than for hepatitis B research, and 5 times more for HIV research than for hepatitis C research. For example, if the federal funder spends $100,000 on HIV research, it only spends $10,000 on hepatitis B research and only $20,000 on hepatitis C research.
A Treatment Only Works if You Can Access It
Other issues that compound the stigma include lack of public awareness, insufficient research funds, inadequate screening, and too little public insurance coverage for viral hepatitis treatment. According to the CLF, fewer than 25% of hepatitis C patients, and fewer than 10% of hepatitis B patients, receive effective treatment. There is no cure for hepatitis B, but there is a vaccine and there are many effective treatments that can keep the disease under control, preventing disease progression and complications thereof. While there is no vaccine for hepatitis C, it is a curable disease for many individuals.
Various provincial formulary restrictions on drug reimbursement, significantly impacted by cost considerations rather than a sole focus on the scientific data, leave many viral hepatitis patients without access to treatment. This can be a frustrating situation for both patients and practitioners.
Effective screening, targeted vaccination programs, and affordable patient access to effective treatments can prevent death and serious illness from liver disease. The CLF and the CCS recommend targeting at-risk groups for screening (certain immigrant populations for hepatitis B, and Canadians born between 1945 and 1975 for hepatitis C) and vaccination (for hepatitis B). Family health practitioners play an important role in educating their patients, with an increasing number also building interest and expertise in the management of liver diseases. Even so, many regions across the country need additional specialists to support the millions of Canadians affected by liver disease.