Community Socioeconomic Deprivation and Nonalcoholic Fatty Liver Disease Severity

Abstract

Background and Objectives: Nonalcoholic fatty liver disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area-level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity. Methods: Retrospective study of patients <21 years with NAFLD, followed from 2009 to 2018. The patients’ addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0--1, higher values indicating higher deprivation, calculated from six SES-related variables available publicly in US Census databases). Results: Two cohorts were evaluated; 1 with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy-confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were boys (66%), non-Hispanic (77%–78%), severely obese (79%–80%), and publicly insured (55%–56%, respectively). The median CDI for both groups was 0.36 (range 0.15–0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI-measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high- and low-deprivation groups. Conclusions: Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.

Relationships between Socioeconomic Status, Handgrip Strength, and Non-Alcoholic Fatty Liver Disease in Middle-Aged Adults

“…When the ORs for risk of NAFLD were estimated with SES and HGS, the ORs of subjects with middle and low SESs were significantly higher compared to those with a high SES ( Table 4 ). Our findings agree with previous studies suggesting that individuals with socioeconomic deprivation are at risk of an earlier onset of NAFLD [ 7 ]. Similarly, the ORs of the subjects with middle and low HGSs were significantly higher compared to those with a high HGS ( Table 4 ).…”

“…A wide variety of risk factors of NAFLD have been identified, such as age, diabetes, hypertension, and hyperlipidemia [ 27 , 28 ]. Recently, growing evidence has shown that SES is also one of the factors influencing the prevalence of NAFLD [ 6 , 7 ]. SES is defined as the position of an individual on a social–economic scale that measures a combination of education, income, occupation, place of residence, heritage, and religion [ 29 , 30 , 31 ].…”

“…Most of these risk factors are modifiable; therefore, clinicians emphasize the importance of aggressive lifestyle changes to improve NAFLD with physical activity, healthy diet, and weight loss. In addition, socioeconomic status (SES) is emergently thought to be an influencing factor for NAFLD [ 6 , 7 ]. Though the reason for SES being included as a risk factor for NAFLD has not been clearly explained, it may closely affect individual lifestyles and living environments.…”

Non-Alcoholic Fatty Liver Disease in Children

“…Social deprivation was determined by the Community Deprivation Index which takes into account income, education, public assistance, housing, and insurance status. Socioeconomic deprivation was associated with earlier onset of NAFLD but not with its severity [ 17 ].…”

Can Baseline Characteristics be Used to Predict Liver Disease Outcomes in Pediatric Nonalcoholic Fatty Liver Disease?

“…Previous studies have linked factors such as sex, age, severity of obesity, ethnicity, and socioeconomic factors to liver disease severity at the cross‐sectional level (7,12,13,25). These variables were not proven to be predictive of liver disease progression or regression in this pediatric cohort.…”