TY - JOUR
T1 - Neighborhood Social Determinants of Health Are Associated With Metabolic Dysfunction-associated Steatotic Liver Disease Outcomes
AU - Faulkner, Claire S.
AU - Aboona, Majd B.
AU - Surendra, Likith
AU - Rangan, Pooja
AU - Ng, Cheng Han
AU - Huang, Daniel Q.
AU - Muthiah, Mark
AU - Kim, Donghee
AU - Fallon, Michael B.
AU - Noureddin, Mazen
AU - Chen, Vincent L.
AU - Kardashian, Ani
AU - Wijarnpreecha, Karn
N1 - Publisher Copyright:
© 2025 AGA Institute
PY - 2025/8
Y1 - 2025/8
N2 - Background & Aims: Significant health disparities exist in metabolic dysfunction-associated steatotic liver disease (MASLD), driven by social determinants of health (SDOH). Few studies have explored neighborhood-level SDOH in MASLD. Methods: This is a retrospective cohort study of patients with MASLD at a multi-state healthcare institution. Primary outcomes were MASLD burden, mortality, and comorbidities by neighborhood SDOH, assessed using the Social Deprivation Index in cross-sectional and longitudinal analyses. Results: A total of 69,191 patients with MASLD were included, 45,003 of which had over 365 days of follow-up. Patients living in the most disadvantaged neighborhoods, as compared with the least, had higher odds of cirrhosis (adjusted odds ratio [aOR], 1.42; P < .001), any cardiovascular disease (aOR, 1.20; P < .001), coronary artery disease (aOR, 1.17; P < .001), congestive heart failure (aOR, 1.43; P < .001), cerebrovascular accident (aOR, 1.19; P = .001), diabetes mellitus (aOR, 1.57; P < .001), and hypertension (aOR, 1.38; P < .001). They also had increased incidence of death (adjusted hazard ratio [aHR], 1.47; P < .001), liver-related events (aHR, 1.31; P = .012), diabetes mellitus (aHR, 1.47; P < .001), and major adverse cardiovascular events (aHR, 1.24; P < .001). Patients in the most disadvantaged neighborhoods compared to the least were disproportionately Hispanic, Black, and Native American/Alaska Native, more often spoke Spanish as their primary language, and were more often uninsured or had Medicaid. Even after adjustment for Social Deprivation Index, Native American/Alaska Native patients had higher incidence of death, cirrhosis, diabetes, and major adverse cardiovascular events compared with non-Hispanic White patients. Conclusion: Neighborhood-level SDOH are associated with MASLD burden, comorbidities, and mortality and should be considered in clinical care, quality improvement, and further research.
AB - Background & Aims: Significant health disparities exist in metabolic dysfunction-associated steatotic liver disease (MASLD), driven by social determinants of health (SDOH). Few studies have explored neighborhood-level SDOH in MASLD. Methods: This is a retrospective cohort study of patients with MASLD at a multi-state healthcare institution. Primary outcomes were MASLD burden, mortality, and comorbidities by neighborhood SDOH, assessed using the Social Deprivation Index in cross-sectional and longitudinal analyses. Results: A total of 69,191 patients with MASLD were included, 45,003 of which had over 365 days of follow-up. Patients living in the most disadvantaged neighborhoods, as compared with the least, had higher odds of cirrhosis (adjusted odds ratio [aOR], 1.42; P < .001), any cardiovascular disease (aOR, 1.20; P < .001), coronary artery disease (aOR, 1.17; P < .001), congestive heart failure (aOR, 1.43; P < .001), cerebrovascular accident (aOR, 1.19; P = .001), diabetes mellitus (aOR, 1.57; P < .001), and hypertension (aOR, 1.38; P < .001). They also had increased incidence of death (adjusted hazard ratio [aHR], 1.47; P < .001), liver-related events (aHR, 1.31; P = .012), diabetes mellitus (aHR, 1.47; P < .001), and major adverse cardiovascular events (aHR, 1.24; P < .001). Patients in the most disadvantaged neighborhoods compared to the least were disproportionately Hispanic, Black, and Native American/Alaska Native, more often spoke Spanish as their primary language, and were more often uninsured or had Medicaid. Even after adjustment for Social Deprivation Index, Native American/Alaska Native patients had higher incidence of death, cirrhosis, diabetes, and major adverse cardiovascular events compared with non-Hispanic White patients. Conclusion: Neighborhood-level SDOH are associated with MASLD burden, comorbidities, and mortality and should be considered in clinical care, quality improvement, and further research.
KW - Health Disparities
KW - Health Equity
KW - Liver Disease
KW - Racial and Ethnic Disparities
UR - https://www.scopus.com/pages/publications/105004595713
UR - https://www.scopus.com/pages/publications/105004595713#tab=citedBy
U2 - 10.1016/j.cgh.2024.10.019
DO - 10.1016/j.cgh.2024.10.019
M3 - Article
C2 - 39675403
AN - SCOPUS:105004595713
SN - 1542-3565
VL - 23
SP - 1577-1587.e10
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 9
ER -