Association of documented social deprivation with cardiovascular and liver outcomes in alcohol-associated liver disease

Background and aims: Alcohol-associated liver disease (ALD) is a growing public health concern, and outcomes may be influenced by social determinants of health. Although social disadvantage has been linked to adverse outcomes in other diseases, its specific association with ALD-related complications is not well defined. Approach: We conducted a retrospective cohort study using the TriNetX research network. Adults with ALD were classified as experiencing documented social deprivation based on International Classification of Diseases, 10th Revision, Clinical Modification codes for extreme poverty (Z59.5), low income (Z59.6), or living alone (Z60.2). A 1:1 propensity score matching approach balanced baseline clinical covariates. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for acute and chronic outcomes. Results: The matched cohort included 998 patients (499 socially deprived, 499 non-deprived). Median follow-up was 1469 days in the documented social deprivation group and 1166 days in the non-deprived group. Documented social deprivation was not associated with all-cause mortality, major adverse liver outcomes, or acute pancreatitis. Socially deprived patients had higher risks of acute complications, including major adverse cardiovascular events (20.6% vs. 11.4%; HR 1.76, 95% CI 1.22–2.56), arrhythmia (24.6% vs. 15.7%; HR 1.58, 95% CI 1.13–2.22), heart failure (13.5% vs. 6.2%; HR 2.15, 95% CI 1.34–3.43), alcohol-associated hepatitis (AH) (24.7% vs. 16.2%; HR 1.44, 95% CI 1.09–1.90), and sepsis (21.8% vs. 10.2%; HR 2.03, 95% CI 1.41–2.93). Conclusions: Documented social deprivation was associated with increased risk of acute cardiovascular, infectious, and AH complications, but not chronic liver progression or mortality, suggesting that social vulnerability differentially affects acute versus chronic outcomes in ALD.