Contribution of social determinants of health to racial disparities in metabolic dysfunction-associated steatotic liver disease among US adults

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Abstract Background Racial and ethnic disparities in metabolic dysfunction-associated steatotic liver disease (MASLD) persist in the US population. We studied the impact of social determinants of health (SDOH) on the likelihood of developing MASLD and explored the contribution of SDOH to racial disparities in MASLD. Methods Data on self-reported SDOH domains and sub-items based on Healthy People 2030 were collected from the US National Health and Nutrition Examination Survey (NHANES) across 10 NHANES cycles from 1999 to 2000 to 2017–2018. The participants were divided into four racial and ethnic groups: White, Black, Hispanic, and other. The primary outcome was MASLD, characterized by a US fatty liver index score exceeding 30. Survey-weighted logistic regression models were used to examine the relationship between SDOH and MASLD. The results were further analysed by race and ethnicity. Results A total of 22,585 participants (10115 White, 4431 Black, 5978 Hispanic, and 2061 other) were included in our analyses, of whom 7798 had MASLD (survey-weighted prevalence 32.0%). The prevalence of USFLI-defined MASLD was significantly higher among Hispanic adults compared to other racial and ethnic groups ( p < 0.001). We found that unemployment, low income, food insecurity, low education level, absence of private health insurance, and renting a home were significantly and independently associated with higher odds of MASLD: odds ratios (ORs) were 1.506 (95% confidence intervals [CIs] 1.379–1.643) for those with unemployment, 1.269 (1.164–1.384) for those with low income, 1.460 (1.329–1.604) for those with food insecurity, 1.274 (1.162–1.398) for those with low education level, 1.130 (1.043–1.224) for those with absence of private health insurance, and 1.122 (1.017–1.237) for those with renting a home. Furthermore, White participants exposed to adverse SDOH seemed more prone to developing MASLD compared to other racial and ethnic groups. Conclusions Unfavorable SDOH are associated with an increased odds of MASLD and contribute to racial disparities in MASLD in the US population. Addressing SDOH through population-based strategies is essential to mitigate MASLD and address racial and ethnic disparities.

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