Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis

Nicole E. Rich, Stefany Oji, Arjmand R. Mufti, Jeffrey D. Browning, Neehar D. Parikh, Mobolaji Odewole, Helen Mayo, Amit G. Singal

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75–100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. Methods: We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. Results: We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%–55.5%) than population-based cohorts (range, 13.0%–22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98–1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60–0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. Conclusions: In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.

Original languageEnglish (US)
Pages (from-to)198-210.e2
JournalClinical Gastroenterology and Hepatology
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Meta-Analysis
Hispanic Americans
Fibrosis
Non-alcoholic Fatty Liver Disease
Ethnic Groups
MEDLINE
Population
Liver Diseases
Chronic Disease
Databases
Mortality

Keywords

  • Disparities
  • Ethnicity
  • Fatty Liver Disease
  • Nonalcoholic Steatohepatitis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{c07e352be7ec4492b84e901a6dfacd7e,
title = "Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States: A Systematic Review and Meta-analysis",
abstract = "Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75–100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. Methods: We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. Results: We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6{\%}–55.5{\%}) than population-based cohorts (range, 13.0{\%}–22.9{\%}). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95{\%} CI, 0.98–1.21) and lower in Blacks (relative risk, 0.72; 95{\%} CI, 0.60–0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. Conclusions: In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.",
keywords = "Disparities, Ethnicity, Fatty Liver Disease, Nonalcoholic Steatohepatitis",
author = "Rich, {Nicole E.} and Stefany Oji and Mufti, {Arjmand R.} and Browning, {Jeffrey D.} and Parikh, {Neehar D.} and Mobolaji Odewole and Helen Mayo and Singal, {Amit G.}",
year = "2018",
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doi = "10.1016/j.cgh.2017.09.041",
language = "English (US)",
volume = "16",
pages = "198--210.e2",
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TY - JOUR

T1 - Racial and Ethnic Disparities in Nonalcoholic Fatty Liver Disease Prevalence, Severity, and Outcomes in the United States

T2 - A Systematic Review and Meta-analysis

AU - Rich, Nicole E.

AU - Oji, Stefany

AU - Mufti, Arjmand R.

AU - Browning, Jeffrey D.

AU - Parikh, Neehar D.

AU - Odewole, Mobolaji

AU - Mayo, Helen

AU - Singal, Amit G.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75–100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. Methods: We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. Results: We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%–55.5%) than population-based cohorts (range, 13.0%–22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98–1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60–0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. Conclusions: In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.

AB - Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the United States, affecting 75–100 million Americans. However, the disease burden may not be equally distributed among races or ethnicities. We conducted a systematic review and meta-analysis to characterize racial and ethnic disparities in NAFLD prevalence, severity, and prognosis. Methods: We searched MEDLINE, EMBASE, and Cochrane databases through August 2016 for studies that reported NAFLD prevalence in population-based or high-risk cohorts, NAFLD severity including presence of nonalcoholic steatohepatitis (NASH) and significant fibrosis, and NAFLD prognosis including development of cirrhosis complications and mortality. Pooled relative risks, according to race and ethnicity, were calculated for each outcome using the DerSimonian and Laird method for a random-effects model. Results: We identified 34 studies comprising 368,569 unique patients that characterized disparities in NAFLD prevalence, severity, or prognosis. NAFLD prevalence was highest in Hispanics, intermediate in Whites, and lowest in Blacks, although differences between groups were smaller in high-risk cohorts (range 47.6%–55.5%) than population-based cohorts (range, 13.0%–22.9%). Among patients with NAFLD, risk of NASH was higher in Hispanics (relative risk, 1.09; 95% CI, 0.98–1.21) and lower in Blacks (relative risk, 0.72; 95% CI, 0.60–0.87) than Whites. However, the proportion of patients with significant fibrosis did not significantly differ among racial or ethnic groups. Data were limited and discordant on racial or ethnic disparities in outcomes of patients with NAFLD. Conclusions: In a systematic review and meta-analysis, we found significant racial and ethnic disparities in NAFLD prevalence and severity in the United States, with the highest burden in Hispanics and lowest burden in Blacks. However, data are discordant on racial or ethnic differences in outcomes of patients with NAFLD.

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KW - Ethnicity

KW - Fatty Liver Disease

KW - Nonalcoholic Steatohepatitis

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