The syndemic of hazardous alcohol consumption, opioid use, and obesity has led to important changes in liver disease epidemiology that have exacerbated health disparities. Health disparities occur when plausibly avoidable health differences are experienced by socially disadvantaged populations. Highlighting health disparities, their sources, and consequences in chronic liver disease is fundamental to improving liver health outcomes. There have been large increases in alcohol use disorder in women, racial and ethnic minorities, and those experiencing poverty in the context of poor access to alcohol treatment, leading to increasing rates of alcohol-associated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged > 50, and individuals experiencing food insecurity. Access to viral hepatitis screening and linkage to treatment are suboptimal for racial and ethnic minorities and individuals who are uninsured or underinsured, resulting in greater liver-related mortality and later-stage diagnoses of HCC. Data from more diverse cohorts on autoimmune and cholestatic liver diseases are lacking, supporting the need to study the contemporary epidemiology of these disorders in greater detail. Herein, we review the existing literature on racial and ethnic, gender, and socioeconomic disparities in chronic liver diseases using a social determinants of health framework to better understand how social and structural factors cause health disparities and affect chronic liver disease outcomes. We also propose potential solutions to eliminate disparities, outlining health-policy, health-system, community, and individual solutions to promote equity and improve health outcomes.

中文翻译：

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慢性肝病的健康差异

有害饮酒、阿片类药物使用和肥胖症的流行导致肝病流行病学发生重大变化，加剧了健康差异。当社会弱势群体经历看似可以避免的健康差异时，就会出现健康差异。强调慢性肝病的健康差异、其来源和后果是改善肝脏健康结果的基础。妇女、少数种族和少数族裔以及因难以获得酒精治疗而陷入贫困的人的酒精使用障碍大幅增加，导致酒精相关肝病的发病率增加。在西班牙裔人、50 岁以上的女性和经历粮食不安全的个人中观察到 NAFLD 和相关纤维化的发病率上升。对于少数民族和未投保或投保不足的个人而言，获得病毒性肝炎筛查和治疗的机会并不理想，导致更高的肝脏相关死亡率和晚期 HCC 诊断。缺乏来自更多不同队列的自身免疫性和胆汁淤积性肝病的数据，支持更详细地研究这些疾病的当代流行病学的需要。在此，我们使用健康框架的社会决定因素回顾了关于慢性肝病的种族和民族、性别和社会经济差异的现有文献，以更好地了解社会和结构因素如何导致健康差异并影响慢性肝病的结果。我们还提出了消除差异的潜在解决方案，概述了卫生政策、卫生系统、社区、