Impact of Documented Social Vulnerability on Clinical Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease.

[BACKGROUND] Social determinants of health (SDoH), including poverty and social isolation, have emerged as important contributors to adverse outcomes of chronic diseases. However, their impact on patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remains poorly characterised. This study aimed to assess the association between social vulnerability in MASLD and liver-related and cardiovascular outcomes.

[METHODS] We conducted a population-based retrospective cohort study using the TriNetX network, which aggregates de-identified electronic health records from healthcare systems across the U.S. Patients with MASLD and at least one International Classification of Diseases, Tenth Revision (ICD-10) code for documented social vulnerability (Z59.5, Z59.6, Z56.0 and Z60.2) were compared to non-socially vulnerable individuals. Outcomes, including major adverse liver outcomes (MALO), major adverse cardiovascular events (MACE), hepatocellular carcinoma (HCC) and other cardiovascular complications, were assessed over a 5-year follow-up using Cox proportional hazards models.

[RESULTS] Individuals with MASLD and documented social vulnerability were at higher risk of MALO (8.3% vs. 4.4%; HR 1.69, 95% CI: 1.42-2.01). Cardiovascular morbidity was consistently elevated including MACE (22.7% vs. 12.5%; HR 1.64, 95% CI: 1.46-1.83), arrhythmias (34.4% vs. 17.8%; HR 1.81, 95% CI: 1.64-2.00) and heart failure (12.4% vs. 6.7%; HR 1.64, 95% CI: 1.42-1.89). The incidence of HCC did not differ between documented socially vulnerable and non-socially vulnerable individuals with MASLD.

[CONCLUSIONS] Documented social vulnerability is independently associated with higher risks of liver and cardiovascular complications in MASLD. These findings underscore the importance of integrating SDoH into MASLD management and risk prediction models to address disparities in long-term outcomes.