Arleen Brown MD
Racial/Ethnic Disparities in mortality in patients with NAFLD
NAFLD refers to the presence of hepatic steatosis, defined as macrovascular fatty infiltration, no explained by other causes. The estimated prevalence of NAFLD approaches 25-30% (1). Clear racial/ethnic disparities exist in rates of NAFLD, with Hispanics (specifically Mexican Americans) at 21.2%, non-Hispanic Whites (NHWs) at 12.5%, and non-Hispanic Blacks (NHBs) at 11.6%.. This disparity points to gaps in medical care of these conditions, and may point to disparities in mortality as well.
To examine racial disparity in NASH-related mortality in a sample, and the factors possibly contributing.
We analyzed data from NHANES III 1988-1994, which is a cross-sectional survey conducted by the National Center for Health Statistics. Included participants between the ages of 20-74 years with complete ultrasound data, leaving an analytic sample of 13,899 participants. Descriptive statistics were used to characterize the study population, using means ± standard error (SE) for continuous variables, and unweighted number/weighted percent for categorical variables. Performed Cox proportional hazards model analysis to determine the predictors of HS, NAFLD, NASH, adjusting for the confounding variables (such as age, sex, behaviors etc).
Mexican Americans and Blacks had higher rates of hepatic steatosis, NAFLD, and NASH.. Adjusted hazard ratios for mortality with NAFLD were 1.29 (1.14-1.48, 95% CI, p= 0.0003) for NHWs, 1.21 (1.04-1.40, 95% CI, p= 0.0139) and Mexican Americans, but did not reach statistical significance for NHBs 1.16 (0.96-1.40 , 95 CI, p= 0.1218). Similar trends were observed for hepatic steatosis and NASH results; however, none of the associations reached statistical significance.
Although Mexican Americans and NHBs had higher prevalence of HS, NAFLD, and NASH, they had comparable or lower mortality relative to NHWs. Additional work is needed to understand the role of demographic, clinical, social, and structural factors in the association between NAFLD, NASH, and HS and mortality.