MON-707 - MASLD Burden in A Safety-Net Hospital: Disparities and Implications for Health Equity

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a leading cause of liver morbidity, often linked to cardiometabolic comorbidities and influenced by social determinants of health (SDOH). In safety net hospitals that predominantly care for underserved populations, characterizing racial disparities in MASLD is crucial, yet studies in these cohorts remain limited.

Methods: We retrospectively evaluated electronic health records of over 28,000 patients seen at our safety net hospital system from 2020 to 2025. Patients with MASLD were identified using ICD-10 codes and stratified by legal sex, age bands, body mass index (BMI), and seven key diagnoses: coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia (DLD), chronic kidney disease (CKD), hypertension (HTN), liver fibrosis, and liver cirrhosis. Racial/ethnic distributions were analyzed using AHS race mapping, with BMI categorized as < 27.0 or ≥27.0. Descriptive statistics highlighted prevalence and disparities.

Results: Among the screened population, 4,037 patients (59% female) were diagnosed with MASLD. The cohort demonstrated a high burden of metabolic comorbidities, particularly DM (1,866; 43.7%), Obesity/Overweight (BMI≥27.0 – 3,871;95.8%), HTN (2,227; 55.1%), and DLD (2,098; 51.9%), while advanced liver disease (liver fibrosis and cirrhosis) was more prevalent in advanced age bands (>50 years). Notably, 98.5% of individuals with MASLD had a BMI ≥27.0, reflecting a large obesity burden in this safety net population. Racial breakdown showed Hispanics as the largest group (2,173; 53.8%), followed by Blacks (579; 14.3%), Whites (518; 12.8%), and Asians (343; 8.5%). Hispanics demonstrated the highest prevalence of comorbidity clustering (e.g., CAD+DM+HTN), potentially tied to SDOH such as limited access to preventive care, food insecurity, and socioeconomic barriers in urban safety net settings.

Conclusions: In this diverse real-world MASLD cohort, Hispanic patients predominated and exhibited near-universal Overweight/Obesity with a high burden of cardiometabolic multimorbidity, underscoring racial disparities amplified by SDOH. These findings highlight the need for targeted interventions and greater representation of Hispanic populations in MASLD research. Future prospective studies should address genetic, environmental, and equity factors to improve health outcomes in underserved communities.

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