Actionable Solutions to Achieve Health Equity in Chronic Liver Disease

Abstract

There are well-described racial and ethnic disparities in the burden of chronic liver diseases. Hispanic persons are at highest risk for developing nonalcoholic fatty liver disease, the fastest growing cause of liver disease. Hepatitis B disproportionately affects persons of Asian or African descent. The highest rates of hepatitis C occur in American Indian and Alaskan Native populations. In addition to disparities in disease burden, there are also marked racial and ethnic disparities in access to treatments, including liver transplantation. Disparities also exist by gender and geography, especially in alcohol-related liver disease. To achieve health equity, we must address the root causes that drive these inequities. Understanding the role that social determinants of health play in the disparate health outcomes that are currently observed is critically important. We must forge and/or strengthen collaborations between patients, community members, other key stakeholders, health care providers, health care institutions, professional societies, and legislative bodies. Herein, we provide a high-level review of current disparities in chronic liver disease and describe actionable strategies that have potential to bridge gaps, improve quality, and promote equity in liver care.

Keywords: Chronic Liver Disease; Diversity; Health Disparities; Health Equity; Quality Improvement; Social Determinants.

Figure 1.

A research framework for investigating health disparities and inequities in patients living with chronic liver disease. Adapted from the National Institute for Minority Health and Health Disparities framework for research in disparities.

Figure 2.

Practical solutions to address disparities and achieve health equity in the short, medium, and long term.