{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:54:16Z","timestamp":1792839256945,"version":"4.5.0"},"reference-count":170,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2022,9,4]],"date-time":"2022-09-04T00:00:00Z","timestamp":1662249600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:p>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\u2010associated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged &gt;\u200950, 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\u2010related mortality and later\u2010stage 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\u2010policy, health\u2010system, community, and individual solutions to promote equity and improve health outcomes.<\/jats:p>","DOI":"10.1002\/hep.32743","type":"journal-article","created":{"date-parts":[[2022,8,22]],"date-time":"2022-08-22T05:49:55Z","timestamp":1661147395000},"page":"1382-1403","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":228,"title":["Health disparities in chronic liver disease"],"prefix":"10.1097","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0068-0099","authenticated-orcid":false,"given":"Ani","family":"Kardashian","sequence":"first","affiliation":[{"name":"Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4899-2160","authenticated-orcid":false,"given":"Marina","family":"Serper","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4143-1950","authenticated-orcid":false,"given":"Norah","family":"Terrault","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0837-0746","authenticated-orcid":false,"given":"Lauren D.","family":"Nephew","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,9,4]]},"reference":[{"issue":"(Suppl 1)","key":"hep32743-bib-0001-20250824","first-page":"S149","article-title":"Health disparities and health equity: the issue is justice","volume":"101","year":"2011","journal-title":"Am J Public Health"},{"key":"hep32743-bib-0002-20250824","first-page":"31","article-title":"Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy","volume":"70","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"hep32743-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.2105\/AJPH.2006.102525","article-title":"Approaching health disparities from a population perspective: the National Institutes of Health centers for population health and health disparities","volume":"98","year":"2008","journal-title":"Am J Public Health"},{"key":"hep32743-bib-0005-20250824","article-title":"Meeting individual social needs falls short of addressing social determinants of health","year":"2019","journal-title":"Health Affairs Blog"},{"key":"hep32743-bib-0006-20250824","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1017\/S1742058X11000130","article-title":"Structural racism and health inequities: old issues, new directions","volume":"8","year":"2011","journal-title":"Bois Rev Soc Sci Res Race"},{"key":"hep32743-bib-0007-20250824","article-title":"The social, economic, political, and genetic value of race and ethnicity in 2020","volume":"14","year":"2020","journal-title":"Hum Genomics"},{"key":"hep32743-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","article-title":"Burden of liver diseases in the world","volume":"70","year":"2019","journal-title":"J Hepatol"},{"key":"hep32743-bib-0009-20250824","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0140-6736(21)01701-3","article-title":"The EASL\u2013Lancet Liver Commission: Protecting the next generation of Europeans against liver disease complications and premature mortality","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"hep32743-bib-0010-20250824","doi-asserted-by":"crossref","first-page":"644","DOI":"10.2471\/BLT.18.211607","article-title":"Gender, health and the 2030 agenda for sustainable development","volume":"96","year":"2018","journal-title":"Bull World Health Organ"},{"key":"hep32743-bib-0011-20250824","article-title":"Gender disparities in clinical practice: are there any solutions? 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