Johns Hopkins University School of Medicine Baltimore, MD
Introduction: In recent years, researchers and clinicians have had increasing interest in understanding the effects of a patient’s neighborhood/community on his/her liver-related health. Due to the complexity of a place-based approach to study health equity (e.g., defining and measuring the multi-faceted nature of a patient’s neighborhood), the tools used and results generated are variable. This study aims to define and compare measures of neighborhood-level social determinants of health (SDOH) used to study liver diseases.
Methods: In this scoping review, we searched PubMed for studies published from 1/1/12 to 12/31/22 containing keywords related to “neighborhood” and “liver diseases”. We screened titles, abstracts, and full texts. We included studies about associations between neighborhood factors and liver diseases and excluded studies in pediatric patients. We reported findings following PRISMA guidelines (Figure 1).
Results: Of 637 articles from our initial search, we reviewed 28 full texts and we included 17 in the scoping review. We identified 10 validated neighborhood indices and 1 custom index (Table 1). We also determined 7 neighborhood variables that were assessed independently (education level, median income, poverty level, region of birth, employment status, primary language spoken at home, and supplemental nutrition assistance program (SNAP) assistance). The most common liver diseases assessed were hepatocellular carcinoma (6/17; 35.2%) and hepatitis C virus (4/17; 23.5%). Of the 11 indices, 8 (73%) included domains related to income, education and employment. The area deprivation index (ADI), which has been validated and extensively studied with a range of health outcomes, included the most domains related to neighborhood SDOH, some of which were not taken into account by the other indices. Of the 17 studies, 12 (70.6%) demonstrated a statistically significant association between neighborhood factors and liver disease outcomes, 3 studies (17.6%) showed no association.
Discussion: This scoping review characterizes the variation, advantages, and disadvantages of several place-based approaches to measure the effect on patients with liver diseases. Despite the different variables used, more than 70% of studies demonstrated an association between neighborhood factors and liver outcomes, which highlights the need for future research. We have also demonstrated the multi-factorial considerations for the careful incorporation of neighborhood-level SDOH into methodological frameworks.
