SDOH, GLP-1 Prescription Patterns and MASLD-associated Liver Disease in a Real World Population

This analysis leveraged 2015–2025 electronic health record data from a large urban academic medical center to examine predictors of advanced liver disease and GLP-1 RA receptor agonist use among a cross-sectional study of adults with metabolic dysfunction–associated steatotic liver disease (MASLD) and related conditions. Variables included diagnoses, prescriptions, demographics, BMI, diabetes, insurance, and ZIP code–linked social determinants (disadvantage, affluence, food access, food insecurity). Covariates were selected using directed acyclic graphs. Most advanced documented subtype (MASH, fibrosis, cirrhosis, or HCC) and GLP-1 RA use were each modeled by multivariable adjusted modified Poisson regression, with diabetes-stratified analyses. After adjusting for clinical and social factors, diabetes status was the strongest predictor of advanced liver outcomes, while higher BMI was inversely associated with severity. This inverse association with BMI is contrary to typical expectations and may reflect the limitations of the cross-sectional design used in this study, rather than a true protective effect. Race/ethnicity, insurance, and neighborhood-level social determinants showed no independent associations with increased risk of fibrosis, cirrhosis, or HCC after adjustment. GLP-1 RA use, observed in 17% of patients, was primarily driven by clinical need. Diabetes was the dominant predictor, and prescribing increased with BMI, regardless of diabetes or liver subtype. GLP-1 RA use was most common with MASH and fibrosis, less so with MASLD, and not higher among those with HCC. Importantly, there were no independent differences in GLP-1 RA use by demographic or neighborhood social factors. Overall, advanced liver disease severity and GLP-1 RA prescribing were consistently linked to metabolic profile, not area-level social determinants.

Author dc:creator

• Satya Manasa Kota (24399038)

• Health Sciences, Public Health
• Metabolic Syndrome
• Liver diseases
• Health Sciences, Medicine and Surgery
• Health Sciences, Oncology
• Health Sciences, Epidemiology

Statement dc:rights

• In Copyright

DOI dc:identifier

https://doi.org/10.25417/uic.32991914.v1

OAI identifier oai:identifier

oai:figshare.com:article/32991914