Abstract
Social determinants of health (SDOH) are crucial in shaping liver health outcomes, yet comprehensive assessments that span key SDOH domains are lacking. To address this knowledge gap, we developed a Social Determinants Disadvantage Score (SDDS) and examined its association with major adverse liver conditions. We conducted a cross-sectional analysis of 117,783 participants from the All of Us Research Program. The SDDS was systematically constructed using validated questionnaires covering economic stability, education, healthcare access and quality, neighborhood and built environment, and social and community context. Each question was scored on a 0 (most advantage) to 1 (most disadvantage) scale. Total SDDS was calculated as the mean of all questions, ranging from 0 to 1. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of SDDS with total and individual adverse liver conditions, including steatotic liver disease (SLD), metabolic dysfunction-associated steatohepatitis (MASH), alcoholic liver disease (ALD), cirrhosis, hepatocellular carcinoma (HCC), chronic hepatitis B virus (HBV), chronic hepatitis C virus (HCV), and hepatic failure based on the Electronic Health Record. Higher SDDS was associated with a higher risk of adverse liver conditions. The highest SDDS quintile (most disadvantaged) compared to the lowest SDDS quintile had an OR = 1.67 (95% CI: 1.55-1.79) for total adverse liver condition risk after adjusting for age, sex, race, and other covariates. Similar associations were observed for individual liver conditions. Per 10% higher SDDS, the adjusted OR (95% CI) was 1.25 (1.22-1.29) for SLD, 1.27 (1.19-1.35) for MASH, 1.15 (0.99-1.34) for ALD, 1.31 (1.25-1.39) for cirrhosis, 1.35 (1.15-1.59) for HCC, 1.24 (1.14-1.35) for HBV infection, 1.40 (1.33-1.48) for HCV infection, and 1.35 (1.21-1.50) for hepatic failure. Consistent associations were found for disadvantages in individual SDOH domains, score excluding missingness, and score with selected factors. The SDDS provides a comprehensive, validated tool for assessing SDOH and their associations with liver health. Our findings highlight significant associations between social disadvantage and the prevalence of adverse liver conditions, emphasizing the need for future longitudinal studies to inform targeted interventions.