Neighborhood Social Determinants of Health Are Associated With Metabolic Dysfunction-associated Steatotic Liver Disease Outcomes

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.