Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Aliment Pharmacol Ther. 2023 Sep;58(5):537-545. doi: 10.1111/apt.17631. Epub 2023 Jul 3.
Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction-associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual-level risk factors. However, there are very limited data on neighbourhood-level SDOH in MASLD.
To assess whether SDOH impact fibrosis progression in patients who already have MASLD.
This was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood-level SDOH, 'disadvantage' and 'affluence'. The primary outcomes were mortality, incident liver-related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan-Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1-year landmark.
We included 15,904 patients with MASLD with median follow-up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37-0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39-0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57-0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54-2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10-1.68], p < 0.0001). These findings were robust across several sensitivity analyses.
Neighbourhood-level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.
健康的社会决定因素（SDOH）正日益被认为是人类健康的中介因素。在代谢功能障碍相关脂肪性肝病（MASLD）的背景下，大多数关于 SDOH 的文献都与个体层面的危险因素有关。然而，关于 MASLD 的社区层面 SDOH 的数据非常有限。
评估 SDOH 是否会影响已经患有 MASLD 的患者的纤维化进展。
这是一项对密歇根大学医学中心就诊的 MASLD 患者进行的回顾性队列研究。主要预测因素是两个社区层面的 SDOH，“劣势”和“富裕”。主要结局是死亡率、新发肝相关事件（LREs）和新发心血管疾病（CVD）。我们使用 Kaplan-Meier 统计方法对死亡率进行建模，使用竞争风险分析对 LREs 和 CVD 进行建模，使用 1 年的时间作为里程碑。
我们纳入了 15904 例 MASLD 患者，中位随访时间为 63 个月。富裕程度较高与总体死亡率降低相关（风险比 0.49 [0.37-0.66]，较高四分位与较低四分位相比，p<0.0001）、LREs（亚风险比 0.60 [0.39-0.91]，p=0.02）和 CVD（亚风险比 0.71 [0.57-0.88]，p=0.0018）。劣势与死亡率升高相关（风险比 2.08 [95%置信区间 1.54-2.81]，最高四分位与最低四分位相比，p<0.0001）和新发 CVD（亚风险比 1.36 [95%置信区间 1.10-1.68]，p<0.0001）。这些发现经过几次敏感性分析后仍然成立。
社区层面的 SDOH 与脂肪性肝病患者的死亡率、LREs 发生率和 CVD 发生率相关。针对劣势社区的干预措施可能会改善临床结局。
