Clin Mol Hepatol.
2023 Oct;29(4):1002-1012. 10.3350/cmh.2023.0205.
Differences in liver and mortality outcomes of non-alcoholic fatty liver disease by race and ethnicity: A longitudinal real-world study
- Nguyen VH1,2
- Le I1,3
- Ha A1
- Le RH1,4
- Rouillard NA1
- Fong A1
- Gudapati S1,5
- Park JE1
- Maeda M1
- Barnett S1
- Cheung R1,6
- Nguyen MH
1,7
- Affiliations
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- 1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA
- 2Harvard Medical School, Boston, MA, USA
- 3Emory University, Atlanta, GA, USA
- 4William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
- 5Washington University, St Louis, MO, USA
- 6Division of Gastroenterology and Hepatology, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA, USA
- 7Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
- KMID: 2546387
- DOI: http://doi.org/10.3350/cmh.2023.0205
Abstract
- Background/Aims
Understanding of nonalcoholic 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.
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