{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:54:31Z","timestamp":1790614471605,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social determinants of health (SDoH), including poverty and social isolation, have emerged as important contributors to adverse outcomes of chronic diseases. However, their impact on patients with metabolic dysfunction\u2010associated steatotic liver disease (MASLD) remains poorly characterised. This study aimed to assess the association between social vulnerability in MASLD and liver\u2010related and cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based retrospective cohort study using the TriNetX network, which aggregates de\u2010identified electronic health records from healthcare systems across the U.S. Patients with MASLD and at least one International Classification of Diseases, Tenth Revision (ICD\u201010) code for documented social vulnerability (Z59.5, Z59.6, Z56.0 and Z60.2) were compared to non\u2010socially vulnerable individuals. Outcomes, including major adverse liver outcomes (MALO), major adverse cardiovascular events (MACE), hepatocellular carcinoma (HCC) and other cardiovascular complications, were assessed over a 5\u2010year follow\u2010up using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Individuals with MASLD and documented social vulnerability were at higher risk of MALO (8.3% vs. 4.4%; HR 1.69, 95% CI: 1.42\u20132.01). Cardiovascular morbidity was consistently elevated including MACE (22.7% vs. 12.5%; HR 1.64, 95% CI: 1.46\u20131.83), arrhythmias (34.4% vs. 17.8%; HR 1.81, 95% CI: 1.64\u20132.00) and heart failure (12.4% vs. 6.7%; HR 1.64, 95% CI: 1.42\u20131.89). The incidence of HCC did not differ between documented socially vulnerable and non\u2010socially vulnerable individuals with MASLD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Documented social vulnerability is independently associated with higher risks of liver and cardiovascular complications in MASLD. These findings underscore the importance of integrating SDoH into MASLD management and risk prediction models to address disparities in long\u2010term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70550","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T09:49:25Z","timestamp":1772963365000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Documented Social Vulnerability on Clinical Outcomes in Metabolic Dysfunction\u2010Associated Steatotic Liver Disease"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9121-165X","authenticated-orcid":false,"given":"Pojsakorn","family":"Danpanichkul","sequence":"first","affiliation":[{"name":"Department of Medicine Texas Tech University Health Sciences Center  Lubbock Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Pang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Youjiang Medical University for Nationalities  Baise Guangxi China"},{"name":"National Immunological Laboratory of Traditional Chinese Medicines  Baise Guangxi China"},{"name":"Center for Medical Laboratory Science Affiliated Hospital of Youjiang Medical University for Nationalities  Baise Guangxi China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5181-363X","authenticated-orcid":false,"given":"Maria","family":"Inggriani","sequence":"additional","affiliation":[{"name":"Department of Medicine Texas Tech University Health Sciences Center  Lubbock Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supapitch","family":"Sirimangklanurak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Chiang Mai University  Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3695-9701","authenticated-orcid":false,"given":"Matheus","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Federal University of Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9488-7364","authenticated-orcid":false,"given":"Ahmad","family":"Anouti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew F.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Medicine Texas Tech University Health Sciences Center  Lubbock Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Duong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G.","family":"Cotter","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"},{"name":"Evidentis Clinical Research  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Noureddin","sequence":"additional","affiliation":[{"name":"Houston Research Institute Houston Methodist Hospital  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karn","family":"Wijarnpreecha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine University of Arizona College of Medicine  Phoenix Arizona USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Banner University Medical Center  Phoenix Arizona USA"},{"name":"BIO5 Institute University of Arizona College of Medicine\u2010Phoenix  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0431"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.7570\/jomes23052"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ueg2.70072"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcell.2024.1433857"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/HC9.0000000000000352"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102023\u2010330595"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003274"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(24)00318\u20108"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(25)00226\u20102"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2025.101645"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2412865"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1332870"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.10.019"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13098\u2010025\u201001694\u20109"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.70409"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000001328"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2025.0474"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.07.021"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcad275"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15874"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101619"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10215019"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32743"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)30003\u2010X"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.156080"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.08.012"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2023.06.027"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.16091"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.02.009"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2025.0802"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2019.02.028"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8584"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.1458"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010024\u201004248\u20105"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl\u20102015\u2010308790"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000124"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003595"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0709"},{"issue":"11","key":"e_1_2_13_40_1","first-page":"672","article-title":"Non Invasive Assessment to Identify Patients With At\u2010Risk Metabolic Dysfunction\u2010Associated Steatohepatitis","volume":"20","author":"Kalligeros M.","year":"2024","journal-title":"Gastroenterology & Hepatology"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1831"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2024.0631"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.focus.2023.100089"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000316"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2020.02.002"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1037\/amp0000103"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13185604"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.14730"},{"key":"e_1_2_13_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.155958"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70550","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.70550","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.70550","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T05:12:35Z","timestamp":1775884355000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.70550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1111\/liv.70550"],"URL":"https:\/\/doi.org\/10.1111\/liv.70550","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"assertion":[{"value":"2026-01-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70550"}}