Global Sociodemographic Disparities in the Severity of Alcohol-Associated Hepatitis.
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Chen Joshua, Díaz Luis Antonio, Idalsoaga Francisco, Blaney Hanna, Rama Kaanthi, Jahagirdar Vinay, Rhoads S Fisher, Danpanichkul Pojsakorn, Valsan Arun, Nair Gowripriya, Gu Hyundam, Arnold Jorge, Ayala-Valverde María, Ramirez-Cadiz Carolina, Jalal Prasun K, Ibrahim Mohamad Ali, Elfeki Mohamed A, Roblero Juan Pablo, Simian Daniela, Velarde José Antonio, Córdova-Gallardo Jacqueline, Higuera-de-la-Tijera Fátima, Silva Rita, Rocha Cristina Melo, Araujo Roberta C, Pereira Gustavo Henrique, Bessone Fernando, Tanno Mario, Kisch Ayelen, Mendizabal Manuel, Marciano Sebastián, Perdiguero Gonzalo Gomez, Montes Pedro, Salazar Patricia Guerra, Ramos Geraldine, Carrera Enrique, Chacko Kristina R, Sadhra Hamza, Oguntoye Oluwatosin, Sterling Richard, Sanyal Arun J, Shah Vijay H, Simonetto Douglas, Dunn Winston, Singal Ashwani K, Kamath Patrick S, Arrese Marco, Bataller Ramon, Arab Juan Pablo
Аннотация
PATIENTS AND METHODS: We conducted a prospective cohort study across 30 centers in 14 countries (January 2015-September 2024). We included adults who met National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for AH. Outcomes included infections, access to liver transplantation (LT), and survival. Mortality was analyzed with Fine-Gray competing-risk models.
RESULTS: Among 726 participants (median age, 49 years; 90.1% male), 24.8% had less than secondary education, and 37.6% reported good social support. Severe AH was more frequent in those without secondary education than in those with at least secondary education (97.2% vs. 81.7%; P<0.0001). The 30- and 90-day survival rates were lower among participants without secondary education (66.4% and 50.4%, respectively) than among those with at least secondary education (88.4% and 81.2%, respectively). In adjusted analyses, moderate and good social support were associated with lower mortality (each sHR 0.58, 95% CI, 0.38-0.89 and 0.38-0.94, respectively), as were secondary (sHR 0.48, 95% CI, 0.24-0.97) and tertiary education (sHR 0.44, 95% CI, 0.20-0.97) and corticosteroid use (sHR 0.63, 95% CI, 0.42-0.95).
CONCLUSIONS: Lower educational attainment and poorer perceived social support were associated with greater AH severity at presentation and higher mortality, independent of clinical risk factors. These findings highlight the need to address social determinants and favor equitable access to evidence-based therapies, including early LT.