Aims Liver disease is the third commonest cause of premature death in the UK. We sought to assess the public health burden of common liver aetiologies in the West Midlands by metrics of premature mortality. Methods Routine data from PHE Alcohol and Liver Disease West Midlands Profiles from 2012-14 were assessed. Sources include the Office of National Statistics mortality and population. Specific aetiologies assessed include: alcoholic liver disease (ALD); non-alcoholic fatty liver disease (NAFLD); chronic viral hepatitis B and C; and hepatocellular cancer (HCC). Results Directly age-standardised liver mortality rates in the West Midlands continue to be higher than the national average from 1995 onwards. Average annual liver disease deaths vary by age (<70 years primarily due to ALD; >70 years primarily due to HCC). Average age of death was decreased compared to overall mortality (M63 vs 74; F66 vs 79 years). Premature mortality under 75 years was higher in West Midlands compared to rest of England (19.2 deaths per 100,000). Despite a higher proportion of teetotallers (22-25%), premature mortality of ALD under 75 years was higher than the national average (10.2 deaths per 100,000). Key Messages 1. Premature liver disease mortality under 75 years is significantly higher in the West Midlands compared to the rest of England. 2. Reliable public health data are invaluable in helping assess major aetiologies and design services. 3. A collaborative liver health network in the West Midlands are required to help tackle the preventable burden.