Letter: Enhancing cirrhosis management—The critical role of social workers in supporting NAFLD surveillance

Abstract

We read with great interest the study by Tran et al.¹ which offers valuable insights into the changing epidemiology of cirrhosis, particularly regarding variations in aetiology and outcomes over the past two decades. These findings are crucial for clinical practice and public health policy. However, we identified some limitations that warrant further discussion.

Firstly, the study relies on administrative claims data, which, despite its comprehensiveness, is prone to misclassification and undercoding.² This can lead to inaccurate estimates of cirrhosis aetiology prevalence and misinterpretations of disease trends. Coding inaccuracies or delays in data collection may result in the underreporting of certain aetiologies. To address this, future research should integrate additional data sources, such as electronic health records and patient registries, to improve patient characterisation and prevalence estimates' accuracy.^{3, 4}

Additionally, the study focusses solely on privately insured patients, introducing a risk of selection bias. This cohort may not represent the broader US population, particularly the uninsured or underinsured, who often experience poorer health outcomes. This bias could result in findings that do not fully reflect the characteristics of the entire US cirrhosis population. Future studies should expand the dataset to include publicly insured (e.g. Medicaid and Medicare)⁵ and uninsured individuals.⁶ Employing weighted or stratified analyses could also help correct biases and enhance the generalisability of the findings.

Thirdly, the authors also did not account for the impact of lifestyle factors, such as diet, physical activity and alcohol consumption, on cirrhosis progression and outcomes.^7-10 These factors are critical in understanding the natural history of cirrhosis, particularly for conditions like non-alcoholic fatty liver disease (NAFLD). Including data on lifestyle factors, perhaps through patient surveys or integration with other datasets, would allow for a more nuanced analysis of risk factors and potential interventions.

Finally, while the study emphasises that NAFLD has become a leading cause of cirrhosis and underscores the need for awareness and monitoring, the development of standardised guidelines for the surveillance and management of NAFLD patients is crucial. Social workers play a pivotal role in this context; they can drive comprehensive community health education initiatives to raise awareness of NAFLD risk factors and prevention strategies. Moreover, they can assist patients in overcoming economic, geographic and cultural barriers to ensure access to timely medical care and regular health monitoring, particularly in high-risk communities. By implementing community-level health screening programmes, social workers can facilitate the early detection and management of NAFLD, thereby preventing its progression to cirrhosis. Additionally, they provide essential psychosocial support to patients and their families, helping them cope with the emotional challenges of disease management. Overall, social workers are integral to the prevention, early intervention and patient support of NAFLD, contributing to the reduction of cirrhosis incidence and the improvement of patient quality of life.

In conclusion, while this study significantly advances our understanding of cirrhosis in the United States, addressing these limitations in future research will further enhance the quality and applicability of the findings.

Senlin Ye: Methodology; formal analysis; writing – original draft. Jinli Liu: Methodology; writing – original draft. Ruyi Zhou: Conceptualization; methodology; supervision; writing – review and editing.

No fundings were received for this research.

The authors declare no conflicts of interest that pertain to this work.

This article is linked to Tran et al papers. To view these articles, visit https://doi.org/10.1111/apt.18024 and https://doi.org/10.1111/apt.18265