Letter: The Essential Role of Social Workers in Reducing Socioeconomic Disparities in Chronic Liver Disease

Abstract

We carefully read the article by Lee et al. [1], which provides valuable insights into the prevalence of chronic liver diseases (CLD) across different income groups in the United States. While the study is commendable, there remain several areas that warrant further exploration and refinement.

First, there is room for improvement in the study's classification of income levels. The authors used the income-to-poverty ratio (IPR) to categorise participants into high, middle and low-income groups, but income alone is an incomplete measure of socioeconomic status (SES). Including additional SES factors such as employment status, neighbourhood conditions and access to healthcare would provide a more nuanced view of how economic disparities affect liver disease risk [2, 3]. Future studies could also consider income instability and economic fluctuations, which may have long-term impacts on health, to offer a more dynamic understanding of different populations.

Second, while the study adjusts for key confounders like age, sex, race and education, further adjustments for lifestyle factors such as diet [4], physical activity [5], alcohol [6], health insurance coverage, occupational risk, mental health [7] and genetic predispositions would strengthen the results. Unhealthy lifestyles and limited healthcare often expose low-income groups, exacerbating their risk of liver disease. Failure to adequately control for these factors could obscure or exaggerate the true relationship between income levels and CLD prevalence.

Third, the use of the U.S. Fatty Liver Index (USFLI) to define non-alcoholic fatty liver disease (NAFLD), although practical for large-scale studies, is not the most accurate diagnostic tool. For future studies, it might be helpful to use non-invasive and more accurate tools, like transient elastography (FibroScan) [8] or magnetic resonance elastography (MRE) [9]. These tools are better at diagnosing problems in large groups of people and give a better picture of how common diseases are across different socioeconomic groups.

Lastly, the study highlights higher liver disease rates in low-income populations due to limited healthcare access, but it does not sufficiently address the role of health literacy and disease awareness. Low-income individuals often lack the knowledge necessary to seek timely care, worsening disease progression [10]. Future studies should focus on the role of health education and social support systems, particularly through community interventions, to improve health literacy and access to care for disadvantaged groups.

Social workers can play a critical role in alleviating the burden of CLD in low-income communities. They can raise awareness about liver disease prevention and management through community education, especially concerning NAFLD and alcohol-related liver disease (ALD). Additionally, social workers can collaborate with healthcare centres to organise low-cost screenings and provide mental health support to address stress-related unhealthy behaviours. They should also engage in policy advocacy to expand insurance coverage and reduce treatment costs. Through case management, social workers can ensure that CLD patients receive comprehensive care, including medical, social and psychological support.

Overall, Lee et al.'s research offers a strong foundation for understanding income-related disparities in CLD. However, incorporating more comprehensive socioeconomic indicators, utilising more accurate diagnostic tools and accounting for a broader range of confounding variables would significantly enhance future studies in this area.

Qiong Yi: methodology, formal analysis, writing – original draft. GuangYao Wang: methodology, writing – original draft. ZongXiang Yue: conceptualization, methodology, supervision, writing – review and editing.

The authors declare no conflicts of interest.

This article is linked to Lee et al papers. To view these articles, visit https://doi.org/10.1111/apt.18242 and https://doi.org/10.1111/apt.18352.