Addressing Social Determinants of Liver Disease During the COVID‐19 Pandemic and Beyond: A Call to Action

Kardashian, Ani; Wilder, Julius; Terrault, Norah A.; Price, Jennifer

doi:10.1002/hep.31605

Cited by 34 publications

(31 citation statements)

References 39 publications

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“…The majority of AIH patients require life-long immunosuppressive therapy, which may increase the risk of bacterial and viral infections [8]. Existing data regarding the clinical presentation and outcome of COVID-19 in patients with AIH is limited to small case series and expert opinions [10][11]. The stage of liver disease has been shown to be risk factor, but it is unclear whether the type of underlying liver disease is a major contributing factor to poor outcomes with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Outcome of COVID‐19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

et al. 2021

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Background: Data regarding outcome of Coronavirus disease 2019 in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods:We performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Accepted ArticleThis article is protected by copyright. All rights reserved Results: We included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe ) and allcause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD.Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p<0.001;). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19.Conclusions: This international, multi-center study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in AIH patients. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19, but did lower the risk for new-onset liver injury during COVID-19.

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Section: Introductionmentioning

confidence: 99%

Outcome of COVID‐19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

et al. 2021

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“…Even though genetic and metabolic factors have a paramount impact on NAFLD prevalence and progression, they do not explain all the observed inequalities. In the field of hepatology, social conditions are closely linked to liver disease prevalence and outcomes, as chronic liver disease disproportionately impacts racial and ethnic minorities, low socioeconomic position communities, and immigrants [55]. Therefore, NAFLD should be understood as context-sensitive and analyzed by taking into account the jointly influence of individual factors, such as genetics or behaviors, social factors such as culture, race, income, and education; environmental factors, such as availability and access to healthy foods, energy-dense foods or the proximity of safe walking spaces; and macro-level factors such as the influence of media and advertising, access to health care or governmental policies [51].…”

Section: Discussionmentioning

confidence: 99%

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Talens

Tumas

Lazarus

et al. 2021

JCM

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With prevalence high and rising given the close relationship with obesity and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is progressively becoming the most common chronic liver condition worldwide. However, little is known about the health inequalities in NAFLD distribution and outcomes. This review aims to analyze health inequalities in NAFLD distribution globally and to assess the health disparities in NAFLD-related outcomes. We conducted a scoping review of global health inequalities in NAFLD distribution and outcomes according to gender/sex, ethnicity/race, and socioeconomic position from PubMed’s inception to May 2021. Ultimately, 20 articles were included in the review, most (75%) of them carried out in the United States. Males were found to have a higher NAFLD prevalence (three articles), while available evidence suggests that women have an overall higher burden of advanced liver disease and complications (four articles), whereas they are less likely to be liver-transplanted once cirrhosis develops (one article). In the US, the Hispanic population had the highest NAFLD prevalence and poorer outcomes (seven articles), whereas Whites had fewer complications than other ethnicities (two articles). Patients with low socioeconomic status had higher NAFLD prevalence (four articles) and a higher likelihood of progression and complications (five articles). In conclusion, globally there is a lack of studies analyzing NAFLD prevalence and outcomes according to various axes of inequality through joint intersectional appraisals, and most studies included in our review were based on the US population. Available evidence suggests that NAFLD distribution and outcomes show large inequalities by social group. Further research on this issue is warranted.

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“…16 A call to action to address social determinants exposed by the COVID-19 pandemic was recently published in Hepatology. 17 The authors summarize the health care inequities in the United States and the impact of social conditions on individual health, especially disparities in liver disease prevalence, outcome, and access to care. This call to action is a natural extension of the ethical and legal considerations as a moral imperative to promote fairness, equitable access to care, compassion, and justice.…”

Section: Pandemic Ethics In Hepatology Practicementioning

confidence: 99%

“…A call to action to address social determinants exposed by the COVID‐19 pandemic was recently published in Hepatology 17 . The authors summarize the health care inequities in the United States and the impact of social conditions on individual health, especially disparities in liver disease prevalence, outcome, and access to care.…”

Section: Pandemic Ethics In Hepatology Practicementioning

confidence: 99%

Ethical and Legal Aspects of Pandemics During COVID‐19 and Beyond for the Hepatology Community

Leeuwen

2021

Clinical Liver Disease

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Pandemics are associated with major human suffering, including ethical and legal challenges that impact daily practice profoundly.• Safety concerns impact all parties concerned, from personal fears of health care workers to infect their beloved to profound economic disasters for health care systems and society. • A transparent ethical and legal framework is mandatory and should include policies toward the powerless and disadvantaged. • The hepatology community needs to revisit their approach to medicine, turning a medical and societal disaster into opportunities to improve the way we deliver care in an equitable and fair way with improved outcomes.Implementing new concepts and policies in clinical hepatology during and after the coronavirus disease 2019 (COVID-19) pandemic requires awareness of ethical and legal issues. Prior pandemics highlight common events that can help guide preparedness for the future. 1,2 Descriptions of prior health catastrophes, such as the bubonic plague, include exhausted health care workers, inability to keep up with the dead, government restrictions, medical professionals under scrutiny, firing of those who brought bad news, overreach by governments, censorship, public anger, and violence. They illustrate the challenges to translate medical advice into workable policies. In 2007, 194 countries, including the United States, signed updated binding international law and with a leading World Health Organization (WHO) role "to prevent, protect, control and provide a public

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Addressing Social Determinants of Liver Disease During the COVID‐19 Pandemic and Beyond: A Call to Action

Cited by 34 publications

References 39 publications

Outcome of COVID‐19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Outcome of COVID‐19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review

Ethical and Legal Aspects of Pandemics During COVID‐19 and Beyond for the Hepatology Community

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