S2643 Racial Disparities in Prevalence of Cirrhosis and Extrahepatic Manifestations in Alcohol-Associated Liver Disease

Introduction: Alcohol-associated liver disease (ALD) is the leading cause of cirrhosis in Western countries and is responsible for 25% of cirrhosis-related deaths. Alcohol can contribute to the development of extrahepatic manifestations. However, limited literature exists regarding extrahepatic outcomes of ALD in diverse patient populations. This study assesses racial disparities in the prevalence of cirrhosis and extrahepatic manifestations in ALD from a diverse cohort. Methods: We included patients with ALD in the Banner Health System, representing hospitals across Arizona, California, Nevada, Wyoming, and Colorado, from 2012 to 2024 using ICD codes with randomly selected chart review of over 250 cases to validate ICD codes for ALD and extrahepatic outcomes. We excluded patients with other causes of liver disease and baseline decompensated cirrhosis. The primary outcomes are the prevalence of any cardiovascular disease (CVD), coronary artery disease (CAD), peripheral artery disease (PAD), cerebrovascular accident (CVA), congestive heart failure (CHF), cirrhosis, and type 2 diabetes mellitus (T2DM) among racial groups. A multivariate logistic regression analysis was performed and adjusted for age, sex, hypertension, T2DM, use of aspirin, statin, glucagon-like peptide-1 receptor agonist, alcohol use treatment, and smoking. Results: The cohort included 16,693 patients with ALD. 66.7% were Non-Hispanic White, 17.9% Hispanic, 11.8% Native American/Alaskan Native (NA), 3.2% Black, and 0.4% Asian/Pacific Islanders. Compared to Non-Hispanic White patients, Hispanic patients had a higher prevalence of cirrhosis (adjusted odds ratio (aOR) 1.38; 95% confidence interval (CI): 1.26–1.51) and T2DM (aOR 2.17; 95% CI: 1.96–2.39). Black patients had a higher prevalence of any CVD (aOR 1.41; 95% CI: 1.13–1.76), CVA (aOR 1.56; 95% CI: 1.11–2.19), CHF (aOR 1.72; 95% CI: 1.31–2.26), and T2DM (aOR 1.58; 95% CI: 1.29–1.94). NA individuals had a higher prevalence of cirrhosis (aOR 2.22; 95% CI: 1.99-2.47) and T2DM (aOR 3.64; 95% CI: 3.23-4.09). Conclusion: In this cohort of patients with ALD, Hispanic and NA patients had a higher prevalence of cirrhosis and DM than Non-Hispanic White patients. Additionally, Black patients had a higher prevalence of CVD. These findings suggest these racial groups may have worse metabolic profiles and cirrhosis, leading to poorer clinical outcomes. Further attention to racial disparities and liver and cardiometabolic risk stratification in patients with ALD is warranted to address these inequities.