Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease
Summary Background Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are v...
Gespeichert in:
| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2023-09, Vol.58 (5), p.537-545 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 545 |
|---|---|
| container_issue | 5 |
| container_start_page | 537 |
| container_title | Alimentary pharmacology & therapeutics |
| container_volume | 58 |
| creator | Chen, Vincent L. Song, Michael W. Suresh, Deepika Wadhwani, Sharad I. Perumalswami, Ponni |
| description | Summary
Background
Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.
Aim
To assess whether SDOH impact fibrosis progression in patients who already have MASLD.
Methods
This was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.
Results
We included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p |
| doi_str_mv | 10.1111/apt.17631 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10720393</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2832840360</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4441-345f7b1d9485285d206f6b4b215b98f803d48d10acc6d2bfc484b0f03687ac523</originalsourceid><addsrcrecordid>eNp1kU1uFDEQhS0EIkNgwQWQJTaw6MR_3e1eoSgKP1IkWIS15bbLjCNPe7DdE82OG8AZOQkeOokACW8sub569VwPoeeUnNB6TvW2nNC-4_QBWlHetQ0jvHuIVoR1Q8Mk5UfoSc7XhJCuJ-wxOuI9H8TQdyv0_cI5MCXj6HCOxuuALRRIGz_paXlegw5ljeOENzEVHXzZYz1Z7CfjLUwFB7-D9PPbjwRBF7AYdnBoPTBGJ-vjTmczB52w9Rl0htqKcwFdYvFmab8rPUWPnA4Znt3ex-jz24ur8_fN5cd3H87PLhsjhKANF63rR2oHIVsmW8tI57pRjIy24yCdJNwKaSnRxnSWjc4IKUbi6lpkr03L-DF6s-hu53ED1lTHSQe1TX6j015F7dXflcmv1Ze4U5T0dbsDrwqvbhVS_DpDLmrjs4EQ9ARxzopJzqSoE0lFX_6DXsc5TfV_lRKSSDZQWanXC2VSzDmBu3dDiTrkrGrO6nfOlX3xp_178i7YCpwuwI0PsP-_kjr7dLVI_gJwa7YT</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2848082918</pqid></control><display><type>article</type><title>Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Chen, Vincent L. ; Song, Michael W. ; Suresh, Deepika ; Wadhwani, Sharad I. ; Perumalswami, Ponni</creator><creatorcontrib>Chen, Vincent L. ; Song, Michael W. ; Suresh, Deepika ; Wadhwani, Sharad I. ; Perumalswami, Ponni</creatorcontrib><description>Summary
Background
Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.
Aim
To assess whether SDOH impact fibrosis progression in patients who already have MASLD.
Methods
This was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.
Results
We included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.
Discussion
Neighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.17631</identifier><identifier>PMID: 37394976</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Confidence intervals ; Fatty Liver ; Fibrosis ; Humans ; Liver diseases ; Mortality ; Neighborhoods ; Retrospective Studies ; Risk Assessment ; Risk factors ; Sensitivity analysis ; Social Determinants of Health</subject><ispartof>Alimentary pharmacology & therapeutics, 2023-09, Vol.58 (5), p.537-545</ispartof><rights>2023 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4441-345f7b1d9485285d206f6b4b215b98f803d48d10acc6d2bfc484b0f03687ac523</citedby><cites>FETCH-LOGICAL-c4441-345f7b1d9485285d206f6b4b215b98f803d48d10acc6d2bfc484b0f03687ac523</cites><orcidid>0000-0002-9964-2585 ; 0000-0002-0157-6066</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.17631$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.17631$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,778,782,883,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37394976$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Vincent L.</creatorcontrib><creatorcontrib>Song, Michael W.</creatorcontrib><creatorcontrib>Suresh, Deepika</creatorcontrib><creatorcontrib>Wadhwani, Sharad I.</creatorcontrib><creatorcontrib>Perumalswami, Ponni</creatorcontrib><title>Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.
Aim
To assess whether SDOH impact fibrosis progression in patients who already have MASLD.
Methods
This was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.
Results
We included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.
Discussion
Neighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.</description><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Confidence intervals</subject><subject>Fatty Liver</subject><subject>Fibrosis</subject><subject>Humans</subject><subject>Liver diseases</subject><subject>Mortality</subject><subject>Neighborhoods</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>Sensitivity analysis</subject><subject>Social Determinants of Health</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU1uFDEQhS0EIkNgwQWQJTaw6MR_3e1eoSgKP1IkWIS15bbLjCNPe7DdE82OG8AZOQkeOokACW8sub569VwPoeeUnNB6TvW2nNC-4_QBWlHetQ0jvHuIVoR1Q8Mk5UfoSc7XhJCuJ-wxOuI9H8TQdyv0_cI5MCXj6HCOxuuALRRIGz_paXlegw5ljeOENzEVHXzZYz1Z7CfjLUwFB7-D9PPbjwRBF7AYdnBoPTBGJ-vjTmczB52w9Rl0htqKcwFdYvFmab8rPUWPnA4Znt3ex-jz24ur8_fN5cd3H87PLhsjhKANF63rR2oHIVsmW8tI57pRjIy24yCdJNwKaSnRxnSWjc4IKUbi6lpkr03L-DF6s-hu53ED1lTHSQe1TX6j015F7dXflcmv1Ze4U5T0dbsDrwqvbhVS_DpDLmrjs4EQ9ARxzopJzqSoE0lFX_6DXsc5TfV_lRKSSDZQWanXC2VSzDmBu3dDiTrkrGrO6nfOlX3xp_178i7YCpwuwI0PsP-_kjr7dLVI_gJwa7YT</recordid><startdate>202309</startdate><enddate>202309</enddate><creator>Chen, Vincent L.</creator><creator>Song, Michael W.</creator><creator>Suresh, Deepika</creator><creator>Wadhwani, Sharad I.</creator><creator>Perumalswami, Ponni</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>M7N</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9964-2585</orcidid><orcidid>https://orcid.org/0000-0002-0157-6066</orcidid></search><sort><creationdate>202309</creationdate><title>Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease</title><author>Chen, Vincent L. ; Song, Michael W. ; Suresh, Deepika ; Wadhwani, Sharad I. ; Perumalswami, Ponni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4441-345f7b1d9485285d206f6b4b215b98f803d48d10acc6d2bfc484b0f03687ac523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Confidence intervals</topic><topic>Fatty Liver</topic><topic>Fibrosis</topic><topic>Humans</topic><topic>Liver diseases</topic><topic>Mortality</topic><topic>Neighborhoods</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk factors</topic><topic>Sensitivity analysis</topic><topic>Social Determinants of Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Vincent L.</creatorcontrib><creatorcontrib>Song, Michael W.</creatorcontrib><creatorcontrib>Suresh, Deepika</creatorcontrib><creatorcontrib>Wadhwani, Sharad I.</creatorcontrib><creatorcontrib>Perumalswami, Ponni</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Vincent L.</au><au>Song, Michael W.</au><au>Suresh, Deepika</au><au>Wadhwani, Sharad I.</au><au>Perumalswami, Ponni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2023-09</date><risdate>2023</risdate><volume>58</volume><issue>5</issue><spage>537</spage><epage>545</epage><pages>537-545</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Social determinants of health (SDOH) are becoming increasingly recognised as mediators of human health. In the setting of metabolic dysfunction‐associated steatotic liver disease (MASLD), most of the literature on SDOH relates to individual‐level risk factors. However, there are very limited data on neighbourhood‐level SDOH in MASLD.
Aim
To assess whether SDOH impact fibrosis progression in patients who already have MASLD.
Methods
This was a retrospective cohort study of patients with MASLD seen at Michigan Medicine. The primary predictors were two neighbourhood‐level SDOH, ‘disadvantage’ and ‘affluence’. The primary outcomes were mortality, incident liver‐related events (LREs) and incident cardiovascular disease (CVD). We modelled these outcomes using Kaplan–Meier statistics for mortality and competing risk analyses for LREs and CVD, using a 1‐year landmark.
Results
We included 15,904 patients with MASLD with median follow‐up of 63 months. Higher affluence was associated with lower risk of overall mortality (hazard ratio 0.49 [0.37–0.66], p < 0.0001 for higher vs. lower quartile), LREs (subhazard ratio 0.60 [0.39–0.91], p = 0.02) and CVD (subhazard ratio 0.71 [0.57–0.88], p = 0.0018). Disadvantage was associated with higher mortality (hazard ratio 2.08 [95% confidence interval 1.54–2.81], p < 0.0001 for the highest vs. lowest quartile) and incident CVD (subhazard ratio 1.36 [95% confidence interval 1.10–1.68], p < 0.0001). These findings were robust across several sensitivity analyses.
Discussion
Neighbourhood‐level SDOH are associated with mortality, incidence of LREs and incident CVD in patients with steatotic liver disease. Interventions aimed at disadvantaged neighbourhoods may improve clinical outcomes.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37394976</pmid><doi>10.1111/apt.17631</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9964-2585</orcidid><orcidid>https://orcid.org/0000-0002-0157-6066</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0269-2813 |
| ispartof | Alimentary pharmacology & therapeutics, 2023-09, Vol.58 (5), p.537-545 |
| issn | 0269-2813 1365-2036 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10720393 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Confidence intervals Fatty Liver Fibrosis Humans Liver diseases Mortality Neighborhoods Retrospective Studies Risk Assessment Risk factors Sensitivity analysis Social Determinants of Health |
| title | Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-16T04%3A34%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effects%20of%20social%20determinants%20of%20health%20on%20mortality%20and%20incident%20liver%E2%80%90related%20events%20and%20cardiovascular%20disease%20in%20steatotic%20liver%20disease&rft.jtitle=Alimentary%20pharmacology%20&%20therapeutics&rft.au=Chen,%20Vincent%20L.&rft.date=2023-09&rft.volume=58&rft.issue=5&rft.spage=537&rft.epage=545&rft.pages=537-545&rft.issn=0269-2813&rft.eissn=1365-2036&rft_id=info:doi/10.1111/apt.17631&rft_dat=%3Cproquest_pubme%3E2832840360%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2848082918&rft_id=info:pmid/37394976&rfr_iscdi=true |