Social Drivers of Health and Cognition in Cirrhosis: A Scoping Review

Social drivers of health (SDOH) play a critical role in influencing health outcomes, including those related to cognitive dysfunction in patients with cirrhosis. Cognitive dysfunction, which can significantly impact the quality of life and health outcomes in patients with cirrhosis, may be influenced by various SDOH factors. This scoping review aims to synthesize current evidence on the association between SDOH and cognition among patients with cirrhosis. A systematic search of the literature was conducted from inception through March 2024 using PubMed, Cochrane Library, and Embase databases. Studies that examined the relationship between SDOH and cognition, as measured by neuropsychological tests, were identified. SDOH were categorized into the five Healthy People 2030 SDOH domains. A total of 31 studies were included in the review; however, many of the studies did not primarily focus on examining the relationship between SDOH and cognition. Cognition was primarily assessed using the Psychometric Hepatic Encephalopathy Score. Education was the most frequently investigated SDOH, followed by employment. Higher levels of education and employment were generally associated with better cognitive performance. The SDOH domains of social and community context and healthcare access and quality were not addressed in the included studies. This review highlights the potential link between SDOH and cognition among patients with cirrhosis but also reveals that existing research is limited, especially beyond education. Future research should address these understudied SDOH factors to inform strategies to identify at-risk patients and improve health outcomes in patients with cirrhosis.