A0501 - Racial/Ethnic Disparities in Long-Term Risks of Cirrhosis Among U.S. Veterans With Metabolic Dysfunction-Associated Fatty Liver Disease

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Aaron J. Yeoh, MD

Stanford University
Palo Alto, CA

Aaron J. Yeoh, MD¹, Zeyuan Yang, MPH², Ramsey Cheung, MD³, Robert Wong, MD, MD, FACG⁴
¹Stanford University, Palo Alto, CA; ²Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA; ³Stanford University School of Medicine, Palo Alto, CA; ⁴Stanford University School of Medicine/Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA

Introduction: Patients with metabolic dysfunction associated fatty liver disease (MAFLD) have high prevalence of concurrent metabolic co-morbidities such as obesity, diabetes, hypertension, and metabolic syndrome. The long-term risks of advanced fibrosis (AF) or cirrhosis in MAFLD patients is not well understood. U.S. Veterans have a high prevalence of metabolic diseases, and this cohort is ideal to evaluate MAFLD outcomes. We evaluated prevalence and predictors of AF and cirrhosis among a national cohort of U.S. Veterans with MAFLD.

Methods: Adult Veterans with MAFLD were identified using data from the 2010-2021 Veterans Affairs Corporate Data Warehouse, which captures national data on over 6 million Veterans receiving health care across the U.S. MAFLD was identified using established definitions: presence of hepatic steatosis plus >1 of the following: 1) obesity, 2) concurrent diabetes mellitus, or 3) >2 metabolic risk factors (hypertension, hypertriglyceridemia, low levels of high-density lipoprotein, insulin resistance, or high-sensitivity C-reactive protein >2 mg/L). Cumulative incidence of AF (fibrosis-4 score >2.67) or cirrhosis (based on ICD-9/10) over a 10-year period was stratified by age, sex, race/ethnicity and other risk factors. Adjusted multivariate Cox proportional hazards models evaluated for predictors of AF or cirrhosis among MAFLD patients.

Results: Overall prevalence of MAFLD among U.S. Veterans was 56.2% (n=2,862,670), among whom the cumulative 10-year incidence of AF was 8.35% and of cirrhosis was 1.69% (Table). Compared to males, females had significantly lower risks of AF (2.46% vs 8.94%, HR 0.55, 95% CI 0.53-0.57) and cirrhosis (0.72% vs 1.79%, HR 0.53, 95% CI 0.50-0.57). Compared to non-Hispanic whites, significantly higher risk of cirrhosis was observed in American Indian/Alaska Natives (HR 1.28, 95% CI 1.14-1.43) and Hispanics (HR 1.14, 95% CI 1.09-1.18), whereas lower risk of cirrhosis was seen in Asians (HR 0.74, 95% CI 0.66-0.82) and African Americans (HR 0.85, 95% CI 0.83-0.88). Significantly higher risk of cirrhosis was seen in those with diabetes (HR 1.68, 95% CI 1.64-1.72).

Discussion: Among a national cohort of U.S. Veterans with MAFLD, overall 10-year incidence of AF was 8.35% and of cirrhosis was 1.69%. Significant racial/ethnic disparities in long-term risks of AF and cirrhosis were observed, with highest risk of cirrhosis in Hispanics and American Indian/Alaska Natives, whereas lowest risk among Asians.

Cumulative Incidence of Advanced Fibrosis
	10-year	95% CI	10-year p-value
Total	8.35%	8.31%, 8.38%	n/a
Female	2.46%	2.39%, 2.52%	ref
Male	8.94%	8.90%, 8.98%	< 0.0001
Non-Hispanic White	8.87%	8.82%, 8.91%	ref
Black or African American	6.72%	6.65%, 6.79%	< 0.0001
Hispanic	7.42%	7.30%, 7.53%	< 0.0001
Asian or Pacific Islander	5.11%	4.90%, 5.31%	< 0.0001
American Indian or Alaska Native	7.71%	7.34%, 8.07%	< 0.0001
No Diabetes	7.12%	7.08%, 7.16%	ref
Diabetes	11.40%	11.33%, 11.48%	< 0.0001
No HIV	8.35%	8.32%, 8.38%	ref
HIV	5.22%	4.28%, 6.16%	< 0.0001
Cumulative Incidence of Cirrhosis
	10-year	95% CI	p-value
Total	1.69%	1.68%, 1.71%	n/a
Female	0.72%	0.69%, 0.76%	ref
Male	1.79%	1.77%, 1.80%	< 0.0001
Non-Hispanic White	1.70%	1.68%, 1.72%	ref
Black or African American	1.68%	1.64%, 1.71%	0.28
Hispanic	1.98%	1.92%, 2.04%	< 0.0001
Asian or Pacific Islander	1.08%	0.99%, 1.18%	< 0.0001
American Indian or Alaska Native	2.12%	1.93%, 2.31%	< 0.0001
No Diabetes	1.29%	1.27%, 1.30%	ref
Diabetes	2.68%	2.64%, 2.71%	< 0.0001
No HIV	1.69%	1.68%, 1.71%	ref
HIV	2.20%	1.59%, 2.81%	0.10

Table: Cumulative incidence of advanced fibrosis and cirrhosis in U.S. Veterans with MAFLD over 10-year period

Disclosures:

Aaron Yeoh indicated no relevant financial relationships.

Zeyuan Yang indicated no relevant financial relationships.

Ramsey Cheung indicated no relevant financial relationships.

Robert Wong: Gilead Sciences – Consultant, Grant/Research Support.

Aaron J. Yeoh, MD¹, Zeyuan Yang, MPH², Ramsey Cheung, MD³, Robert Wong, MD, MD, FACG⁴. A0501 - Racial/Ethnic Disparities in Long-Term Risks of Cirrhosis Among U.S. Veterans With Metabolic Dysfunction-Associated Fatty Liver Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.