Rodriguez Luis A, Tucker Lue-Yen S, Saxena Varun, Levin Theodore R
Division of Research, Kaiser Permanente Northern California, Pleasanton, California.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
Gastro Hep Adv. 2025 Jan 28;4(5):100630. doi: 10.1016/j.gastha.2025.100630. eCollection 2025.
The estimated prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in US adults is 31.3%. However, little is known about MASLD diagnosis rates in clinical practice. We used data from electronic health records and assessed the annual MASLD prevalence.
We conducted a repeated cross-sectional analysis of a retrospective dynamic cohort study among 2,040,688-2,852,060 Kaiser Permanente Northern California adult members without other chronic liver diseases from 2009 to 2018. Annual MASLD prevalence was identified based on International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification diagnosis codes, the application of natural language processing of all radiology imaging report text that included the liver, and the application of the Dallas Steatosis Index, a MASLD prediction algorithm.
Between 2009 and 2018, the estimated MASLD prevalence ranged from 0.37% to 0.95% using diagnosis codes, 0.88%-1.37% using imaging, and 6.14%-11.27% using the Dallas Steatosis Index.
Reliance on diagnosis codes or natural language processing on hepatic imaging, or the Dallas Steatosis Index, to identify MASLD patients within a large health-care system yields much lower than expected prevalence. These results underscore an underdiagnosis issue and highlight the need for improved diagnostic practices.
美国成年人中代谢功能障碍相关脂肪性肝病（MASLD）的估计患病率为31.3%。然而，关于临床实践中MASLD的诊断率知之甚少。我们使用电子健康记录中的数据评估了年度MASLD患病率。
我们对2009年至2018年期间北加利福尼亚州凯撒医疗集团2,040,688 - 2,852,060名无其他慢性肝病的成年成员进行了一项回顾性动态队列研究的重复横断面分析。基于国际疾病分类第九版或第十版临床修订版诊断代码、对所有包含肝脏的放射学影像报告文本进行自然语言处理以及应用MASLD预测算法达拉斯脂肪变性指数来确定年度MASLD患病率。
2009年至2018年期间，使用诊断代码估计的MASLD患病率为0.37%至0.95%，使用影像学为0.88% - 1.37%，使用达拉斯脂肪变性指数为6.14% - 11.27%。
在一个大型医疗保健系统中，依靠诊断代码、肝脏影像学的自然语言处理或达拉斯脂肪变性指数来识别MASLD患者，其患病率远低于预期。这些结果强调了诊断不足的问题，并突出了改进诊断方法的必要性。
