Screening for social determinants of health among populations at risk for MASLD: a scoping review

Abstract

Background: Social determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors.

Methods: Through a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension.

Results: Ten studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c.

Conclusion: Despite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.

Keywords: SDoH screening; diabetes; hypertension; metabolic dysfunction-associated steatotic liver disease; obesity.

Figure 1

Simplified directed acyclic graph (DAG) depicting the relationship between social determinants of health (SDoH) and metabolic dysfunction-associated steatotic liver disease (MASLD). The DAG includes the direct effect of SDoH on MASLD (red pathway), as well as the indirect effect through mediators (yellow pathway). The blue pathway represents the way in which the covariates modify the effect of SDoH on MASLD (effect modifiers). Clinical conditions related to MASLD, and health-related behaviors are green representing their roles as both mediators (yellow) and effect modifiers (blue). *Made with graphics from Biorender.com.

Figure 2

Flow diagram of study selection.

Figure 3

Proposed long-term health systems outcomes that result from standardized, comprehensive social determinants of health screening – Awareness, Adjustment, Assistance, Alignment, and Advocacy.