Neighborhood Social Cohesion Associated With Chronic Liver Disease Prevalence and All-Cause Mortality

Neighborhood social cohesion (NSC)-the degree of trust and solidarity within a community-may influence health through multiple pathways including shaping healthy norms, perception of safety, and stress. Whether NSC influences chronic liver disease (CLD) prevalence and associated mortality in the United States is unknown.

Using 172,047 adults from the 2013-2018 National Health Interview Survey with linkage to National Death Index mortality data, NSC was measured using questions on help availability, accountability, trustworthiness, and connectedness among neighbors, with composite scores (4-16) categorized as minimal (4-7), low (8-10), moderate (11-13), and high (14-16). Logistic and Cox regression tested the association between NSC and CLD, and the interaction of NSC and CLD status on all-cause mortality, respectively.

Lower NSC was associated with increased odds of CLD: moderate NSC adjusted odds ratio (aOR): 1.10 (confidence interval (CI) 1.03-1.18), low NSC aOR: 1.23 (CI 1.12-1.35), and minimal NSC aOR: 1.36 (CI 1.22-1.52) vs high NSC (trend P < .001). After adjusting for sociodemographic and comorbidity covariates, minimal NSC was associated with a 38% higher mortality risk among adults with CLD (adjusted hazard ratio [aHR]: 1.87, CI 1.40-2.51) vs non-CLD (aHR:1.36, CI 1.21-1.53) (interaction effect aHR: 1.38, CI 1.01-1.89, interaction P = .046). Further adjustment for insurance and employment attenuated the interaction effect (CLD: aHR: 1.59, CI 1.18-2.13; non-CLD: aHR: 1.24, CI 1.10-1.39; interaction effect: aHR: 1.28, CI 0.94-1.76, interaction P = .12).

Lower NSC associates with CLD in a dose-response manner. US adults with CLD appear more vulnerable to low NSC and face higher mortality risk than those without CLD. Enhancing social cohesion may offer novel pathways to improve liver health.