# Racial Disparities in Mortality Rates among Patients with Hepatic Steatosis, Non-Alcoholic Fatty Liver Disease, and Non-Alcoholic Steatohepatitis: Insights from NHANES III Data

## TL;DR

This study finds that Mexican American and Black patients with liver diseases have lower mortality rates than White patients, despite higher disease prevalence.

## Contribution

The study provides new insights into racial disparities in mortality for liver diseases using NHANES III data.

## Key findings

- Mexican American and Black patients had lower mortality rates for NAFLD, NAFL, and NASH compared to White patients.
- White patients showed higher hazard ratios for NAFLD and NAFL compared to other racial groups.
- NASH mortality rates were comparable across racial/ethnic groups.

## Abstract

Insufficient research has been done on NASH-related cirrhosis mortality and potential racial disparities in mortality rates.

This study aims to analyze racial differences in mortality rates among patients with non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty liver (NAFL), and non-alcoholic steatohepatitis (NASH), hypothesizing that hazard ratios for mortality among patients with NAFLD, NAFL, and NASH would be significantly different for Mexican American patients compared to other racial groups.

Data from NHANES III (1988–1994) representing the U.S. population were analyzed. Bivariate analysis and Cox proportional hazards models were employed to determine mortality rates and predictors across different racial/ethnic groups, adjusting for variables age, gender, smoking status (current, former, non-smoker), BMI (normal, overweight, obese), and a series of biomarkers.

The prevalence of liver diseases in the sample was: NAFLD (12.1%), NAFL (20.0%), and NASH (3.1%). Deceased patients with NASH had the highest weighted mortality rate (50.6%), followed by NAFLD (39.1%) and NAFL (35.5%). Compared to White patients, Black and Mexican American patients exhibited lower mortality rates for NAFLD. Mexican American patients also had lower mortality rates for NFAL and NASH. White patients showed higher hazard ratios (HR) for NAFLD and NAFL compared to Black and Mexican–American patients. However, for NASH, there were no significant differences in HR between racial/ethnic groups.

Despite higher prevalence rates among Mexican American and Black patients, their mortality rates for NAFLD, NAFL, and NASH were comparable or lower than those for Whites. This highlights the need for further research to inform better management and treatment strategies.