Background: 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 (SDI) 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 to the least, had higher odds of cirrhosis (adjusted odds ratio [aOR] 1.42, p<0.001), any cardiovascular disease (aOR 1.20, p<0.001), coronary artery disease (aOR 1.17, p<0.001), congestive heart failure (aOR 1.43, p<0.001), cerebrovascular accident (aOR 1.19, p=0.001), diabetes mellitus (aOR 1.57, p<0.001), and hypertension (aOR 1.38, p<0.001). They also had increased incidence of death (adjusted hazard ratio [aHR] 1.47, p<0.001), liver-related events (aHR 1.31, p=0.012), diabetes mellitus (aHR 1.47, p<0.001), and major adverse cardiovascular events (MACE, aHR 1.24, p<0.001). Patients in the most disadvantaged neighborhoods compared to the least were disproportionately Hispanic, Black, and Native American/Alaska Native (NA/AN), more often spoke Spanish as their primary language, and were more often uninsured or had Medicaid. Even after adjustment for SDI, NA/AN patients had higher incidence of death, cirrhosis, diabetes, and MACE compared to 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.
Keywords: DEI; Health disparities; Health equity; Liver disease; Racial and ethnic disparities.
Copyright © 2024. Published by Elsevier Inc.