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Missed Opportunities in Guideline-Based Fatty Liver Screening Among 3.5 Million Children
Reema Gulati1, Kabir Gulati2, Hafiza Mehreen Durrani1
1Department of Pediatrics (R Gulati, DC Kaelber, and HM Durrani), The MetroHealth System and Case Western Reserve University, Cleveland, Ohio.
Insights
Screening for metabolic dysfunction-associated steatotic liver disease (MAFLD) in obese children is low at 9.3%. Female gender, White race, and Medicaid insurance were linked to higher screening rates, indicating a need for improved adherence.
Area of Science:
- Pediatric Gastroenterology
- Public Health
- Health Services Research
Background:
- Metabolic dysfunction-associated steatotic liver disease (MAFLD) is a growing concern in pediatric populations.
- Obesity is a primary risk factor for MAFLD development in children.
- Current screening rates for MAFLD in obese children are not well-established.
Purpose of the Study:
- To determine the screening rates for MAFLD in a large cohort of obese children.
- To examine the socio-demographic factors associated with MAFLD screening in this population.
Main Methods:
- Utilized aggregated electronic health record data from Explorys (IBM) across the United States.
- Identified obese children aged 10-14 years based on BMI or ICD obesity codes.
- Calculated MAFLD screening rates by alanine aminotransferase testing, stratified by gender, race, and insurance status.
Main Results:
- Out of 3,558,420 children, 14.4% were obese; only 9.3% of obese children received MAFLD screening.
- Females (OR 1.09) and White children (OR 1.21) showed higher screening likelihood.
- Children with Medicaid insurance had increased screening rates (OR 1.34) compared to those with non-Medicaid insurance.
Conclusions:
- The overall screening rate for MAFLD in obese children is significantly low.
- Screening rates are influenced by gender, race, and insurance type.
- There is a critical need to enhance MAFLD screening adherence in pediatric populations, potentially through health quality measures.
Objective:
Determine screening rates and examine socio-demographic characteristics of metabolic dysfunction-associated steatotic liver disease (MAFLD) screening in a large population of obese children.
Methods:
We used Explorys (IBM) which contains aggregated population-level electronic health record data from approximately 360 hospitals and 317,000 providers across the United States to determine MAFLD screening rates. In children 10 to 14 years, obesity was determined based on body mass index ≥ 95%, or encounter with an international classification of disease obesity code. We determined screening rates by calculating the percentage of children with obesity who had an alanine aminotransferase tested, further analyzed by gender, race, and insurance.
Results:
Of 3,558,420 children, 513,170 (14.4%) were obese. Of obese children, only 9.3% were screened for MAFLD. Females were more likely screened than males (odds ratio (OR) 1.09 (95% confidence intervals (CI): 1.07-1.12)); White children were more likely screened than non-White children (OR 1.21 (95% CI: 1.18-1.23)), and children with Medicaid more likely screened than children with non-Medicaid insurance (OR 1.34 (95% CI: 1.32-1.37)).
Conclusions:
The percentage of obese children receiving screening for MAFLD was low. Female gender, White race, and Medicaid insurance were associated with increased screening rates. These findings highlight the need to increase adherence to MAFLD screening. Reporting screening as a health quality measure may reduce implementation gaps in MAFLD screening.
