Abstract
Background
Social Determinants of Health (SDoH) are non-clinical factors shaping inequities in risk exposure and outcomes. This interim analysis evaluates their role in liver disease severity in two cohorts of Italian patients in care: the ITA-MASLD (Italian Metabolic Dysfunction-Associated Steatotic Liver Disease) cohort (n = 169) and the PITER (Italian Platform for the Study of Viral Hepatitis Therapies and Outcomes) cohort of chronic viral hepatitis patients (n = 81), focusing on fibrosis progression as a proxy of liver cancer risk.
Methods
SDoH were assessed using standardised questionnaires based on domains including education, economic security, social context, and environment. Severe fibrosis was defined as F3–F4. Comparative and multivariate analyses were performed.
Results
In MASLD, severe fibrosis was associated with economic insecurity (p = 0.0258) and low education (p = 0.0106), while no association was observed with occupational status (p = 0.4616). In PITER, vulnerability was higher, with unemployment at 20% vs 6.6% and difficulty coping with unexpected expenses at 50% vs 21.9%. Multivariate analysis confirmed economic insecurity (OR = 2.78, 95% CI 1.27–6.35), low education (OR = 2.31, 95% CI 1.04–5.27), and age (OR = 1.07/year) as independent predictors of severe fibrosis in the MASLD cohort. Occupational status (OR = 0.42, 95% CI 0.16–1.08) and sex (OR = 0.56, 95% CI 0.23–1.32) were not associated with severe fibrosis in the MASLD, yet to be defined in the PITER cohort. Across cohorts, better socioeconomic conditions were associated with milder disease, whereas vulnerable groups showed higher F4 prevalence (56.3% vs 39.5%).
Conclusions
Social disadvantage is a key determinant of liver disease severity across etiologies. These findings support risk-based approaches that integrate SDoH evaluation with clinical factors. Embedding social vulnerability in care pathways is essential to ensure no one is left behind and to reduce inequities in liver disease and cancer risk.
Key messages
• We show that patients with less education and financial stability are more at risk of developing severe fibrosis, supporting the claim that living conditions strongly affect liver disease.
• This evidence suggests enhancing tailored actions for reducing unjust health inequalities associated to social status, emphasizing the need to reach the lower social strata.