Social Determinants of Health in Metabolic Dysfunction‐Associated Steatotic Liver Disease and All‐Cause/Cause‐Specific Mortality

BACKGROUND: Social determinants of health (SDoH) are the preventable health inequities, and the associations between SDoH and health outcomes among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. AIMS: We investigated the relationship between SDoH and mortality in individuals with MASLD in the US. METHODS: We conducted a retrospective analysis using data from the 2007-2016 National Health and Nutrition Examination Survey, with follow-up mortality data assessed through 2019. SDoH score was derived from questionnaires, and MASLD was defined using non-invasive panels and cardiometabolic criteria. Cox regression models were used to evaluate the association between SDoH and all-cause/cause-specific mortality among individuals with MASLD. RESULTS: We analysed 12,321 individuals with MASLD (mean age: 47.0 years; 48.4% males). Over a median follow-up period of 7.6 years, higher SDoH scores were associated with progressively increased hazards of all-cause mortality. The results remained consistent in a multivariable model. Additionally, higher unfavourable SDoH scores were associated with increased cardiovascular and cancer-related mortality. Specifically, there was a 32% increase in hazards for all-cause mortality (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.25-1.38) and increases of 29% and 21% for cardiovascular (HR: 1.29, 95% CI: 1.19-1.40) and cancer-related mortality (HR: 1.21, 95% CI: 1.07-1.36), respectively, for each one-point increase in SDoH score. Employment status, food insecurity, family income, private insurance coverage, and marital status were independently associated with all-cause mortality in individuals with MASLD. CONCLUSIONS: This US population-based study demonstrates that SDoH scores are dose-dependently associated with increased all-cause/cause-specific mortality among individuals with MASLD.