Social Determinants of Health Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease Prevalence and Severity: A Systematic Review and Meta-analysis

Background & Aims: Social determinants of health (SDOH) impact disease risk and severity leading to health disparities. SDOH impacting metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence and severity are poorly characterized and results are conflicting. The aim of this systematic review and meta-analysis was to assess the impact of individual SDOH factors on MASLD burden for adults in the United States (US). Methods: We searched MEDLINE, Embase and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies from January 2010- May 2024 were included. Quantitative studies of adults in the US that evaluated SDOH beyond race/ethnicity were included. Outcomes included prevalence of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), MASH-associated advanced fibrosis or cirrhosis and clinical outcomes. Results: We identified 18 studies comprising of 547,634 total subjects from 11 unique cohorts. Nine studies evaluated MASLD prevalence, three MASH prevalence, six MASH-associated advanced fibrosis/cirrhosis prevalence, and nine clinical outcomes. High diet quality was the most consistent SDOH factor associated with both MASLD and MASH-associated advanced fibrosis/cirrhosis prevalence (summarized OR of 0.76 p <0.01, and 0.74 p <0.01, respectively). Lower income was most consistently associated with risk of clinical outcomes (significant in 3/9 studies). Conclusions: Diet quality was the most consistent SDOH associated with disease prevalence and severity in MASLD, with other SDOH showing inconsistent associations. Prospective assessments using consensus, validated tools to assess the impact of specific SDOH on MASLD burden in heterogenous patient populations are needed to inform public health interventions.