Disparate outcomes in Hispanic patients with metabolic dysfunction-associated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are a growing health burden across a significant portion of the global patient population. However, these conditions seem to have disparate rates and outcomes between different ethnic populations. The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma (HCC), and Hispanic patients experience the greatest burden, particularly those in South Texas.

Aim: To compare outcomes between Hispanic and non-Hispanic patients in the United States, while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration.

Methods: This cohort analysis was conducted with data obtained from TriNetX, LLC ("TriNetX"), a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide. Two cohort networks were used: University of Texas Medical Branch (UTMB) hospital and the United States national database collective to determine whether disparities were related to geographic regions, like Southeast Texas.

Results: This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC, type 2 diabetes mellitus, and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups. All-cause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort.

Conclusion: This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.

Keywords: Diabetes mellitus; Hepatocellular carcinoma; Hispanic; Metabolic dysfunction-associated steatohepatitis; Metabolic dysfunction-associated steatotic liver disease; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Steatotic liver disease; TriNetX.

Figure 1

Histological appearance of metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis at 100 × magnification (hematoxylin and eosin stain). A: A non-alcoholic fatty liver diseases activity score (NAS) 3/8; B: A NAS 6/8 which constitutes a moderate-severe steatohepatitis. Blue triangles denote macrovesicular steatosis. Black stars denote ballooned hepatocytes. Black bars in lower right corner denote scale bar of 50 μm.

Figure 2

Patient demographic flow chart. The chart demonstrates the total number of metabolic dysfunction-associated steatohepatitis patients in both United States and University of Texas Medical Branch cohorts, total number of Hispanic/Latino and non-Hispanic/Latino patients in each cohort, the effects of Propensity Score Matching on cohort size, and the total number of male and female patients in each sub-cohort. MASH: Metabolic dysfunction-associated steatohepatitis; UTMB: University of Texas Medical Branch; HCO: Healthcare organizations.

Figure 3

Kaplan-Meier survival analysis curves for United States and University of Texas Medical Branch cohorts. Hispanic/Latino patients are represented in red, while non-Hispanic/Latino patients are represented in blue. The four primary outcomes (all-cause mortality, hepatocellular carcinoma, type 2 diabetes mellitus, and fibrosis/cirrhosis of the liver) are represented for both cohorts. MASH: Metabolic dysfunction-associated steatohepatitis; UTMB: University of Texas Medical Branch; HCC: Hepatocellular carcinoma; T2DM: Type 2 diabetes mellitus.