Racial Disparities in Clinical and Cardiometabolic Outcomes Among Patients with Alcohol-Associated Liver Disease

Purpose: We assess racial disparities in the prevalence and incidence of clinical outcomes in alcohol-associated liver disease (ALD) in a diverse US population. Methods: This is a retrospective multicenter study on patients aged 18–80 years with ALD in the Banner Health System from 2012 to 2024. Patients with major adverse liver outcomes (MALO) (ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleeding) at baseline were excluded. Primary outcomes included mortality and the incidence of MALO, cardiovascular diseases (CVD) (coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular accidents (CVA), peripheral artery disease), type II diabetes mellitus (DM), cirrhosis, major adverse cardiovascular events (MACE) (CAD, CHF, CVA, mortality), and all-cause cancer. Competing risk and Cox proportional hazard regression analyses were used for outcome modeling. Results: The cohort included 16,693 patients with ALD. The median age was 50.3 and 67.8% were male. The racial distribution was 66.7% Non-Hispanic White (NHW), 0.4% Asian/Pacific Islander, 3.2% Black, 17.9% Hispanic, and 11.8% Native American/Alaskan (NA). Compared to NHW patients, NA patients had higher mortality (aHR: 1.85, 95% CI: 1.50–2.27) and higher incidence of MALO (aHR: 1.19, 95% CI: 1.04–1.37), cirrhosis (aHR: 1.51, 95% CI: 1.28–1.79) and MACE (aHR: 1.38, 95% CI: 1.20–1.59). Conclusion: NA patients with ALD had higher mortality and incidence of adverse clinical outcomes compared to NHW. Further research is warranted to explore these disparities and develop tailored interventions to improve outcomes.