DOI: 10.1097/hc9.0000000000001036 ISSN: 2471-254X

Targeted community screening in areas of high socioeconomic deprivation enhances the detection of liver fibrosis

Huw F. Purssell, Stephanie R. Landi, Alexander A. Warner-Levy, Lucy R. Bennett, Jennifer A. Scott, Christopher E. Mysko, Deepankar Gahloth, Oliver E. Street, Indra Neil Guha, Neil A. Hanley, Karen Piper Hanley, Varinder S. Athwal
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Background:

Risk-factor-based community screening has been used to identify early liver disease. Risk-factor prevalence and liver-related outcomes are significantly affected by socioeconomic deprivation. However, the impact on targeted community screening is unknown. We evaluated the influence of deprivation on fibrosis detection within a population screening pathway.

Methods:

A total of 1613 patients were assessed using 2 pathways: Proactive case finding at 7 primary care practices (PCPs) and a comparator standard-of-care pathway. Individuals with specific risk factors were identified: obesity (BMI >30 kg/m 2 ), type 2 diabetes, alcohol consumption >400/>280 g/week in males/females, respectively, coding for steatosis and ALT >50/>35 IU/mL in males/females, respectively. Liver stiffness measurement (LSM) ≥8.0 kPa was used to determine fibrosis, and the Index of Multiple Deprivation (IMD) was used to determine deprivation at the individual and neighborhood level.

Results:

In all, 325 (20.1%) patients had LSM ≥8.0 kPa. Fibrosis detection increased with the number of risk factors [2: OR 2.47 ( p =0.027, 95% CI 1.11–5.50), 3: OR 5.19 ( p <0.001, 95% CI 2.34–11.53), 4: OR 10.19 ( p <0.001, 95% CI 4.44–23.40), 5: OR 23.40 ( p <0.001, 95% CI 6.15–89.04)]. Patients with a low IMD score (<10) had significantly lower median LSMs than those with a high IMD score (>50) [5.4 kPa vs. 6.0 kPa ( p =0.0005)]. In the proactive case finding pathway, obesity prevalence was higher in PCPs in areas of high deprivation [83.5% vs. 65.6% ( p =0.003)]. Fibrosis detection was significantly higher in PCPs situated in neighborhoods with high socioeconomic deprivation compared with low deprivation [27.0% vs. 8.6% ( p =0.028)].

Conclusion:

Liver fibrosis detection was disproportionately higher in neighborhoods with greater socioeconomic deprivation. Screening strategies targeting areas with higher deprivation could increase the diagnostic yield of advanced fibrosis.

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