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

ABSTRACT 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.