Differences in liver and mortality outcomes of non-alcoholic fatty liver disease by race and ethnicity: A longitudinal real-world study

• Type of Material: Article
• Authors: Vy H. Nguyen, Stanford University; Isaac Le, Emory University; Audrey Ha, Stanford University; Richard Hieu Le, Stanford University; Nicholas Ajit Rouillard, Stanford University; Ashley Fong, Stanford University; Surya Gudapati, Stanford University; Jung Eun Park, Stanford University; Mayumi Maeda, Stanford University; Scott Barnett, Stanford University; Ramsey Cheung, Stanford University; Mindie H. Nguyen, Stanford University
• Language: English
• Date: 2023-09-11
• Publisher: The Korean Association for the Study of the Liver
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by The Korean Association for the Study of the Liver
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): https://doi.org/10.3350/cmh.2023.0205
• Title of Journal or Parent Work: Clinical and Molecular Hepatology
• Volume: 29
• Issue: 4
• Start Page: 1002
• End Page: 1012
• Grant/Funding Information: Research funding: Gilead, Siemens Healthineers.
• Keywords: Health inequities; Natural history; Epidemiology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background/Aims Understanding of non-alcoholic fatty liver disease (NAFLD) continues to expand, but the relationship between race and ethnicity and NAFLD outside the use of cross-sectional data is lacking. Using longitudinal data, we investigated the role of race and ethnicity in adverse outcomes in NAFLD patients. Methods Patients with NAFLD confirmed by imaging via manual chart review from any clinics at Stanford University Medical Center (1995–2021) were included. Primary study outcomes were incidence of liver events and mortality (overall and non-liver related). Results The study included 9,340 NAFLD patients: White (44.1%), Black (2.29%), Hispanic (27.9%), and Asian (25.7%) patients. For liver events, the cumulative 5-year incidence was highest among White (19.1%) patients, lowest among Black (7.9%) patients, and similar among Asian and Hispanic patients (~15%). The 5-year and 10-year cumulative overall mortality was highest for Black patients (9.2% and 15.0%, respectively, vs. 2.5–3.5% and 4.3–7.3% in other groups) as well as for non-liver mortality. On multivariable regression analysis, compared to White patients, only Asian group was associated with lower liver-related outcomes (aHR: 0.83, P=0.027), while Black patients were at more than two times higher risk of both non-liver related (aHR: 2.35, P=0.010) and overall mortality (aHR: 2.13, P=0.022) as well as Hispanic patients (overall mortality: aHR: 1.44, P=0.022). Conclusions Compared to White patients, Black patients with NAFLD were at the highest risk for overall and non-liver-related mortality, followed by Hispanic patients with Asian patients at the lowest risk for all adverse outcomes. Culturally sensitive and appropriate programs may be needed for more successful interventions.