Attribution of diabetes to the development of severe liver disease in the general population

Background and Aims Diabetes is associated with advanced liver disease and predicts mortality regardless of the primary aetiology of the liver disease. Even a family history of diabetes has been linked to advanced liver fibrosis in non‐alcoholic fatty liver disease (NAFLD). However, the fraction of liver‐related outcomes in the general population that are attributable to diabetes remains unclear. Methods The population attributable fraction (PAF) of diabetes for liver disease as a time‐dependent exposure was estimated in the Finnish FINRISK study (n = 28 787) and the British Whitehall II study (n = 7855). We also assessed the predictive ability of a family history of diabetes for liver‐related outcomes. Incident diabetes data were from drug purchase/reimbursement and healthcare registries (FINRISK) or follow‐up examinations (Whitehall II). Incident severe liver outcomes were identified through linkage with national healthcare registries. Results Diabetes was associated with a two‐fold risk of liver‐related outcomes in both the FINRISK (HR, 1.92; p