Disparities in Health Care in Patients With Chronic Liver Disease

Chronic liver disease (CLD) is increasing in prevalence worldwide. CLD has significant associated morbidity and mortality, including a negative impact on health-related quality of life (HRQOL), progression to cirrhosis, development of hepatocellular carcinoma (HCC), and need for liver transplantation. CLD disproportionately impacts racial, ethnic, sexual, and gender minorities. CLD is also more prevalent in populations experiencing challenging social determinants of health (SDOH) factors. Health disparities are prevalent across various forms of CLD, reflected in higher disease prevalence and severity, premature or excess adverse clinical outcomes and worse patient-reported outcomes. In this review, we highlight current epidemiology and health disparities across major forms of CLD, including metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease (ALD), viral hepatitis, and autoimmune liver disease. Herein we discuss challenges with respect to disparities in screening, diagnosis, noninvasive testing for risk stratification, treatment, and rates of clinical outcomes. We outline actionable interventions from a broad public health level to the individual patient level with the goal of moving towards health equity. Lastly, we highlight areas in need of future research that can inform future interventions to achieve health equity.