Table_1_Screening for social determinants of health among populations at risk for MASLD: a scoping review.docx

BackgroundSocial determinants of health (SDoH) have been associated with disparate outcomes among those with metabolic dysfunction-associated steatotic liver disease (MASLD) and its risk factors. To address SDoH among this population, real-time SDoH screening in clinical settings is required, yet optimal screening methods are unclear. We performed a scoping review to describe the current literature on SDoH screening conducted in the clinical setting among individuals with MASLD and MASLD risk factors.
MethodsThrough a systematic literature search of MEDLINE, Embase, and CINAHL Complete databases through 7/2023, we identified studies with clinic-based SDoH screening among individuals with or at risk for MASLD that reported pertinent clinical outcomes including change in MASLD risk factors like diabetes and hypertension.
ResultsTen studies (8 manuscripts, 2 abstracts) met inclusion criteria involving 148,151 patients: 89,408 with diabetes and 25,539 with hypertension. Screening was primarily completed in primary care clinics, and a variety of screening tools were used. The most commonly collected SDoH were financial stability, healthcare access, food insecurity and transportation. Associations between clinical outcomes and SDoH varied; overall, higher SDoH burden was associated with poorer outcomes including elevated blood pressure and hemoglobin A1c.
ConclusionDespite numerous epidemiologic studies showing associations between clinical outcomes and SDoH, and guidelines recommending SDoH screening, few studies describe in-clinic SDoH screening among individuals with MASLD risk factors and none among patients with MASLD. Future research should prioritize real-time, comprehensive assessments of SDoH, particularly among patients at risk for and with MASLD, to mitigate disease progression and reduce MASLD health disparities.

背景：健康社会决定因素（Social determinants of health, SDoH）已被证实与代谢功能障碍相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease, MASLD）患者及其高危人群的异质性临床结局密切相关。针对该人群开展健康社会决定因素筛查，需在临床场景中实施实时筛查，但目前尚无公认的最优筛查方案。本研究通过范围综述，系统梳理当前针对MASLD患者及高危人群开展的临床场景下SDoH筛查相关文献。
方法：截至2023年7月，我们对MEDLINE、Embase及CINAHL Complete数据库开展系统性文献检索，筛选出针对MASLD患者或高危人群开展基于临床场景的SDoH筛查、且报告了包括糖尿病、高血压等MASLD相关危险因素变化在内的相关临床结局的研究。
结果：共计10项研究（8篇期刊论文、2篇会议摘要）符合纳入标准，涉及148151名患者，其中89408名合并糖尿病，25539名合并高血压。筛查主要在基层医疗机构开展，所使用的筛查工具种类多样。最常采集的SDoH维度包括经济稳定性、医疗服务可及性、食物不安全及交通出行情况。临床结局与SDoH间的关联存在异质性；总体而言，更高的SDoH负担与更差的临床结局相关，包括血压升高及糖化血红蛋白A1c（hemoglobin A1c）水平升高。
结论：尽管已有大量流行病学研究证实临床结局与SDoH间存在关联，且相关指南已推荐开展SDoH筛查，但目前针对MASLD高危人群开展临床场景下SDoH筛查的研究仍较为匮乏，针对确诊MASLD患者的相关研究更是空白。未来研究应优先针对MASLD高危人群及确诊患者开展实时、全面的SDoH评估，以延缓疾病进展并缩小MASLD相关健康不平等。