Letter: The Essential Role of Social Workers in Reducing Socioeconomic Disparities in Chronic Liver Disease—Author's Reply

Abstract

We appreciate the feedback we have received on our recent study on income disparities among those with chronic liver disease (CLD) [1-3]. As the authors of the correspondence noted, there are many socio-determinants of health that play a role in a person's liver health status [4]. However, given the large association of education level with income and income with where one lives and what benefits persons may have in the United States, the income-to-poverty ratio may provide a broader range of disparity than any one single factor [5]. Additionally, data are limited in the NHANES dataset and have changed over time such that the income-to-poverty ratio was the most consistent variable to use in order to provide trends over time. In this context as well, although NHANES now provides FibroScan for the measurement of steatosis and fibrosis, these data were only available starting in the 2017–2018 dataset so are not a good trending measure to use at this time [6, 7].

We thank the correspondence authors for allowing us further discussion of the importance of the community in improving liver health. We also agree that considering the multifaceted aspect of socio-determinants of health is very important in the development of effective interventions. We hope the suggested studies will be undertaken in the future as we all work together to improve liver health.

Eunice Yewon Lee: writing – review and editing, project administration. Linda Henry: writing – original draft. Mindie H. Nguyen: writing – review and editing, supervision.

MHN: Research funding: Pfizer, Enanta, Astra Zeneca, Delfi Technologies, GSK, Gilead, CurveBio, Exact Sciences, Helio Health, Glycotest, Vir Biotech; Consulting: Exelixis, Gilead, Intercept, GSK, Exact Science.

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.18307.