Community Socioeconomic Deprivation Predicts Nonalcoholic Steatohepatitis

Area of Science:

• Hepatology
• Public Health
• Socioeconomic Determinants of Health

Background:

• Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are significant health concerns.
• The impact of socioeconomic deprivation on NAFLD/NASH prevalence and severity requires further investigation.

Purpose of the Study:

• To determine the relationship between socioeconomic deprivation and the presence and severity of NAFLD/NASH.
• To assess the association between socioeconomic factors and specific NAFLD/NASH parameters, including steatosis and fibrosis.

Main Methods:

• Retrospective review of 1,430 patients with liver biopsy in a New York health care network.
• Derivation of the Social Deprivation Index (SDI) using zip codes from US Bureau of the Census data.
• Logistic regression analysis to evaluate associations between SDI, socioeconomic factors, and NAFLD/NASH severity.

Main Results:

• 614 patients with NAFLD/NASH were analyzed; median SDI was 31.5.
• Higher SDI was associated with higher Hemoglobin A1c levels (P=0.02).
• Four or more socioeconomic parameters significantly predicted NASH (OR, 1.71; P=0.0190) and six or more predicted severe steatosis (OR, 1.498; P=0.0338).

Conclusions:

• A greater number of socioeconomic determinants are associated with increased severity of NASH.
• Significant fibrosis was not significantly correlated with the number of socioeconomic parameters.
• Increased awareness of NAFLD/NASH is crucial in communities experiencing high socioeconomic deprivation.