Letter: Addressing the Growing Disparities in Alcohol-Associated Liver Disease—A Call for Equitable Healthcare Strategies

Abstract

We read with great interest the study by Cotter et al. discussing disparities in hospital encounters for alcohol-associated liver disease (ALD) in a Texas-based cohort [1]. Their findings provide critical insights into racial, ethnic and socioeconomic disparities in ALD burden, particularly among Hispanic and non-Hispanic Black women. The observed rise in ALD seen in both young and older women underscores a growing public health challenge that warrants immediate action.

Beyond the disparities outlined by Cotter et al., additional structural and biological factors further deepen inequities in the outcomes of patients with ALD. Genetic predisposition, particularly polymorphisms in PNPLA3 and TM6SF2 genes, may contribute to variations in disease progression and severity across various racial and ethnic groups [2]. Future studies incorporating genetic data could provide valuable insights into disease susceptibility and prognosis in overlooked populations.

In addition to genetic factors, systemic barriers to timely diagnosis play a crucial role in worsening ALD disparities. A systematic review by Faugno et al. highlights how diagnostic delays disproportionately affect racial and ethnic minorities due to low health literacy, distrust in healthcare systems, cognitive biases among providers and fragmented healthcare infrastructure [3]. These same barriers likely contribute to ALD disparities, leading to delayed diagnoses, advanced disease presentation and restricted access to life-saving interventions such as liver transplantation.

Furthermore, the COVID-19 pandemic appears to have worsened ALD disparities, as evidenced by the significant rise in hospital encounters during Era 2 (April 2020–December 2021). Given the well-documented increase in alcohol consumption and psychological distress during the COVID-19 pandemic [4], it could be valuable to assess the long-term consequences of these shifts in ALD burden, treatment accessibility and transplant eligibility.

Multi-level interventions are thus necessary to close these gaps. Mitigating these healthcare disparities is possible by expanding Medicaid eligibility, including mental health and addiction treatment services in hepatology care, through a comprehensive healthcare approach and improved provider education regarding implicit biases. Moreover, early screening programs for alcohol use disorder (AUD) and ALD should be oriented towards appropriate racial and ethnic groups who are at high risk in order to prevent diagnostic delays and help enhance patient prognosis.

Finally, we commend the authors for their valuable contribution to the literature on ALD disparities and encourage future investigations that integrate genetic, socioeconomic and healthcare access factors to further refine our understanding of these critical issues.

Mohamed El-Kassas: conceptualization, writing – review and editing. Abdel-Naser Elzouki: writing – review and editing, conceptualization. Khalid M. AlNaamani: conceptualization, writing – review and editing.

IRB approval was not required because no data was collected for this article.

The authors declare no conflicts of interest.

This article is linked to Cotter et al. papers. To view this articles, visit https://onlinelibrary.wiley.com/doi/10.1111/apt.18477 and https://doi.org/10.1111/apt.70158.