Community Socioeconomic Deprivation Predicts Nonalcoholic Steatohepatitis

Abstract

In order to determine the relationship between socioeconomic deprivation and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH), we retrospectively reviewed the electronic medical records of 1,430 patients in a large tertiary health care network in New York. These patients underwent liver biopsy over a 10-year period and were included in our study if they had evidence of NAFLD/NASH on liver biopsy. Zip codes were used to obtain data necessary to derive the social deprivation index (SDI) from the US Bureau of the Census. The high-SDI group was compared to the low-SDI group. Univariate and multivariate logistic regressions were performed to assess association between socioeconomic factors and NAFLD parameters, including presence of NASH (NAFLD activity score >4), moderate to severe steatosis (>33%), and significant fibrosis (S2-S4). We included 614 patients with NAFLD/ NASH; the median SDI was 31.5. Hemoglobin A1c values were higher in the high-SDI group compared to the low-SDI group (6.46 vs. 6.12, P = 0.02). Socioeconomic factors, such as private versus public health care, percentage being foreign born, percentage without a car, percentage with higher needs (<5 years old and >65 years old), and percentage currently living in renter-occupied and crowded housing units, showed statistically significant associations in predicting NASH. After adjusting for patient age, sex, race, body mass index, and diabetes, we saw a significant association between four or more socioeconomic parameters in predicting NASH (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.099-2.856; P = 0.0190) and six or more socioeconomic parameters in predicting severe steatosis (OR, 1.498; 95% CI, 1.031-2.176; P = 0.0338) but no significant correlation between the number of socioeconomic parameters and significant fibrosis. Conclusion: Greater number of socioeconomic determinants (four or more) are associated with greater severity of NASH. Awareness of NAFLD/NASH needs to be raised in communities with high socioeconomic deprivation. (Hepatology Communications 2022;6:550-560).N onalcoholic fatty liver disease (NAFLD) has a current global prevalence of 24%, with nonalcoholic steatohepatitis (NASH) representing 25% of this population. NAFLD is expected to increase by approximately 30% globally, affecting 100 million people solely in the United States over the next decade. (1)(2)(3)(4) This increase in prevalence of NAFLD will predominately affect areas of growing urbanization and decreasing population size. (4) The increasing clinical impact of NAFLD is already becoming obvious. In the 5-year period between 2012 and 2017, there was greater than a 20% and 15% increase in deaths related to liver cancer and cirrhosis, respectively, in patients initially diagnosed with NAFLD/NASH. (5) In addition, it is well known that people with NAFLD are also at risk for cardiometabolic disease, nonhepatocellular carcinoma, malignancy, lung disease, and diabetes. (6,7) Globally, NAFLD stands as the number one cause of end-stage liver di...

Sex and age differences in the association of fatty liver index-defined non-alcoholic fatty liver disease with cardiometabolic risk factors: a cross-sectional study

“…Growing evidence suggests that socio-economic status is inversely related to the prevalence of NAFLD [ 62 – 65 ], and that lower incomes and education levels are associated with worse liver outcomes [ 66 ]. Social status has a significant influence in predicting NAFLD, and during routine clinical practice, those who belong to lower social classes should be accurately screened for a possible higher risk [ 66 ]. The social class effect on health and disease has been observed to possibly start from early adolescence and diminish with increasing age [ 67 ].…”

Editorial: Social determinants of health in steatotic liver disease—Generating community‐level data to maximise community impact

“…However, emerging data suggest that neighbourhood-level SDOH may affect both the development and progression of SLD. 6,7 Chen et al 8 have expanded on this work by examining the association between two well established neighbourhood-level SDOH ('disadvantage' and 'affluence') and clinical outcomes among patients with metabolic dysfunction-associated SLD (MASLD) seen at a single centre in Michigan. Increased neighbourhood disadvantage was associated with higher mortality and incident cardiovascular disease (CVD); higher neighbourhood affluence was associated with lower mortality, CVD and liver-related events (LRE).…”

The growing prevalence of nonalcoholic fatty liver disease (NAFLD), determined by fatty liver index, amongst young adults in the United States. A 20-year experience

“…Additionally, it was interesting to find that NAFLD individuals were less likely to be smokers. However, the negative association between NAFLD and smoking should be interpreted with caution as previous studies have reported contrasting associations between smoking and NAFLD [40][41][42] , and the effect of smoking may be too premature to manifest in young adults. Interestingly, lower income levels are also significantly associated with NAFLD diagnosis.…”