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Background <p>Gastrointestinal (GI) and liver diseases impose a substantial burden on the United Kingdom’s health system, ranking among theleading causes of mortality, cancer-related deaths, and hospital admissions. Despite the universal framework of the National HealthService (NHS), profound inequalities persist across socioeconomic, geographic, and ethnic lines.</p> Objectives <p>This review focuses on colorectal cancer (CRC) and hepatocellular carcinoma (HCC) as exemplar conditions, synthesising currentevidence on disparities across the care continuum and exploring strategies to mitigate them.</p> Methods <p>Current national data and published evidence were reviewed to assess inequities in disease prevalence, access to care, andoutcomes across socioeconomic strata, regions, and ethnic groups. The analysis also examined workforce distribution, policyframeworks, and emerging interventions aimed at addressing these disparities.</p> Results <p>Disease prevalence and outcomes are markedly worse in socioeconomically deprived regions; liver disease mortality is more thantwice as high in the poorest deciles, and CRC survival is significantly lower among disadvantaged populations. Access to careremains uneven—deprived groups exhibit lower CRC screening uptake, delayed diagnoses, and higher emergency presentationrates. Routine HCC surveillance in at-risk patients is inconsistently delivered. Workforce shortages and maldistribution exacerbatethese inequities, with under-resourced regions facing longer waiting times and limited specialist access. Systemic challenges,including social determinants, data deficits, and policy underprioritisation, further hinder progress.</p> Emerging Developments <p>Promising advances include the NHS’s expansion of community diagnostic centres, targeted workforce investment, national hepatitisC virus (HCV) elimination programmes, and structural interventions such as minimum unit pricing for alcohol. Technologicalinnovations—including non-invasive diagnostics and digital tools—offer additional opportunities to bridge care gaps.</p> Conclusions <p>Targeted actions, such as implementing primary care FibroScan services, CRC outreach initiatives with GP endorsement, and patientnavigation for HCC surveillance, are critical to reducing inequalities and improving outcomes. By addressing upstream determinantsand ensuring that innovations reach under-served populations, the UK can progress toward reducing GI health inequalities, improvingoutcomes, and achieving more uniform digestive health across all communities.</p>

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Inequalities in Gastrointestinal Care Provision in the United Kingdom

  • 期刊论文

  • 发表日期：

    2025年10月6日

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  • Hareesha Rishab Bharadwaj,
  • Dushyant Singh Dahiya,
  • Priyal Dalal,
  • Muhtasim Fuad,
  • Arkadeep Dhali,
  • Balamrit Singh Sokhal,
  • Thai Hau Koo,
  • Dhruv Gandhi,
  • Aditya Gaur,
  • Muhammad Ibrahim,
  • Hafiz Ali Raza,
  • Eyad Gadour,
  • Farhan Gohar

摘要

Background

Gastrointestinal (GI) and liver diseases impose a substantial burden on the United Kingdom’s health system, ranking among theleading causes of mortality, cancer-related deaths, and hospital admissions. Despite the universal framework of the National HealthService (NHS), profound inequalities persist across socioeconomic, geographic, and ethnic lines.

Objectives

This review focuses on colorectal cancer (CRC) and hepatocellular carcinoma (HCC) as exemplar conditions, synthesising currentevidence on disparities across the care continuum and exploring strategies to mitigate them.

Methods

Current national data and published evidence were reviewed to assess inequities in disease prevalence, access to care, andoutcomes across socioeconomic strata, regions, and ethnic groups. The analysis also examined workforce distribution, policyframeworks, and emerging interventions aimed at addressing these disparities.

Results

Disease prevalence and outcomes are markedly worse in socioeconomically deprived regions; liver disease mortality is more thantwice as high in the poorest deciles, and CRC survival is significantly lower among disadvantaged populations. Access to careremains uneven—deprived groups exhibit lower CRC screening uptake, delayed diagnoses, and higher emergency presentationrates. Routine HCC surveillance in at-risk patients is inconsistently delivered. Workforce shortages and maldistribution exacerbatethese inequities, with under-resourced regions facing longer waiting times and limited specialist access. Systemic challenges,including social determinants, data deficits, and policy underprioritisation, further hinder progress.

Emerging Developments

Promising advances include the NHS’s expansion of community diagnostic centres, targeted workforce investment, national hepatitisC virus (HCV) elimination programmes, and structural interventions such as minimum unit pricing for alcohol. Technologicalinnovations—including non-invasive diagnostics and digital tools—offer additional opportunities to bridge care gaps.

Conclusions

Targeted actions, such as implementing primary care FibroScan services, CRC outreach initiatives with GP endorsement, and patientnavigation for HCC surveillance, are critical to reducing inequalities and improving outcomes. By addressing upstream determinantsand ensuring that innovations reach under-served populations, the UK can progress toward reducing GI health inequalities, improvingoutcomes, and achieving more uniform digestive health across all communities.