Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hepatol Commun. 2023 Dec 1;7(12). doi: 10.1097/HC9.0000000000000324.
The global liver community established a more precise criteria to characterize steatotic liver disease (SLD), specifically metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated and alcohol-associated liver disease (MetALD). We aimed to estimate the burden of SLD subtypes and unfavorable social determinants of health (SDOH) in US adults and whether clinical and social factors drive disparities across racial/ethnic subgroups.
We evaluated 4263 persons aged 20 years or older from the National Health and Nutrition Examination Survey 2017-2018. We estimated the weighted age-adjusted prevalence and severity of SLD, examined the prevalence of SDOH across SLD subtypes, and performed stepwise regression analysis to evaluate associations between race/ethnicity and SLD, accounting for metabolic risks, alcohol use, and SDOH.
Hispanic adults had the highest prevalence of MASLD (22.3%), MASLD-predominant MetALD (10.3%), alcohol-associated liver disease (ALD)-predominant MetALD (5.6%), and ALD (5.4%). Hispanic adults with MASLD had the highest prevalence of high-risk metabolic dysfunction-associated steatohepatitis (18.0%) and advanced fibrosis (21.1%), whereas non-Hispanic (NH) White adults with MetALD had the highest prevalence of high-risk metabolic dysfunction-associated steatohepatitis (19.3%), advanced fibrosis (19.5%), and cirrhosis (8.1%). Adults with ALD-predominant MetALD and ALD had an increased burden of unfavorable SDOH than those with MASLD, particularly food insecurity, limited health care access, and single living. In stepwise regression, the odds of SLD in Hispanic adults decreased after adjusting for metabolic risks (OR 1.40, 95% CI, 1.06-1.84) and alcohol use (OR 1.36, 95% CI, 1.01-1.82). Differences did not persist after adjusting for cumulative SDOH and nativity status (OR 1.22, 95% CI, 0.89-1.68).
We found substantial disparities in the burden of unfavorable SDOH across SLD subtypes, particularly among those with ALD-predominant MetALD and ALD. Population-based approaches targeting SDOH may mitigate racial/ethnic differences among US adults with SLD.
全球肝脏领域专家制定了更精确的标准来描述脂肪性肝病（SLD），特别是代谢功能障碍相关脂肪性肝病（MASLD）和代谢功能障碍相关且酒精相关的肝病（MetALD）。我们旨在评估美国成年人中 SLD 亚型的负担和不良健康社会决定因素（SDOH），并探讨临床和社会因素是否会导致不同种族/族裔亚组之间存在差异。
我们评估了来自 2017-2018 年全国健康和营养检查调查的 4263 名 20 岁或以上的成年人。我们估计了 SLD 的加权年龄调整患病率和严重程度，检查了 SLD 亚型之间 SDOH 的患病率，并进行逐步回归分析，以评估种族/族裔与 SLD 之间的关联，同时考虑代谢风险、饮酒和 SDOH。
西班牙裔成年人 MASLD（22.3%）、MASLD 为主的 MetALD（10.3%）、酒精相关的 MetALD（5.6%）和 ALD（5.4%）的患病率最高。患有 MASLD 的西班牙裔成年人中，高危代谢功能障碍相关脂肪性肝炎（18.0%）和晚期纤维化（21.1%）的患病率最高，而非西班牙裔白人成年人中 MetALD 中高危代谢功能障碍相关脂肪性肝炎（19.3%）、晚期纤维化（19.5%）和肝硬化（8.1%）的患病率最高。ALD 为主的 MetALD 和 ALD 患者的不良 SDOH 负担高于 MASLD 患者，尤其是食物无保障、医疗保健获取受限和独居。逐步回归分析表明，调整代谢风险（比值比[OR] 1.40，95%可信区间[CI] 1.06-1.84）和饮酒（OR 1.36，95%CI 1.01-1.82）后，西班牙裔成年人患 SLD 的几率降低。在调整累积 SDOH 和出生国地位（OR 1.22，95%CI 0.89-1.68）后，差异不再存在。
我们发现，在 SLD 各亚型的不良 SDOH 负担方面存在显著差异，尤其是在 ALD 为主的 MetALD 和 ALD 患者中。针对 SDOH 的基于人群的方法可能会减轻美国 SLD 患者的种族/族裔差异。
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