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Meta-Analysis
. 2018 Feb;16(2):198-210.e2.
doi: 10.1016/j.cgh.2017.09.041. Epub 2017 Sep 29.

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  1 , Stefany Oji  1 , Arjmand R Mufti  1 , Jeffrey D Browning  1 , Neehar D Parikh  2 , Mobolaji Odewole  1 , Helen Mayo  3 , Amit G Singal  4
Affiliations
Meta-Analysis

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 et al. Clin Gastroenterol Hepatol. 2018 Feb.

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.

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Conflict of interest statement

Disclosures: None of the authors have relevant conflicts of interest.

Figures

Figure 1
Figure 1
A. NAFLD prevalence among Hispanics vs. Whites in population-based and high-risk cohorts B. NAFLD prevalence among Blacks vs. Whites in population-based and high-risk cohorts
Figure 1
Figure 1
A. NAFLD prevalence among Hispanics vs. Whites in population-based and high-risk cohorts B. NAFLD prevalence among Blacks vs. Whites in population-based and high-risk cohorts
Figure 2
Figure 2
A. Presence of NASH and advanced fibrosis among patients with NAFLD for Hispanics vs. Whites B. Presence of NASH and advanced fibrosis among patients with NAFLD for Blacks vs. Whites
Figure 2
Figure 2
A. Presence of NASH and advanced fibrosis among patients with NAFLD for Hispanics vs. Whites B. Presence of NASH and advanced fibrosis among patients with NAFLD for Blacks vs. Whites
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