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S3-E12 – Non-Hispanic Black Americans, SDOH and NASH

Although non-Hispanic Black Americans experience lower rates of Fatty Liver Disease, Social Determinants of Health (SDOH) lead to less favorable outcomes when the disease occurs.

Food Insecurity is Associated With Mortality Among U.S. Adults With Nonalcoholic Fatty Liver Disease and Advanced Fibrosis, Ani Kardashian, Jennifer L. Dodge and Norah A. Terrault, Clinical Gastroenterology and Hepatology, December 16, 2021, Trends in the Incidence of Hepatocellular Carcinoma in Washington DC: A Single Institutional Cohort Study (1959–2013), Zaki A. Sherif, Mehdi Nouraie, Edward Lee and Farshad Aduli, Journal of the National Medical Association, February 2021

In recognition of Black History Month, SurfingNASH looks at how the impact of NASH on non-Hispanic Black Americans differs from other groups. The episode includes Key Opinion Leaders not only in Fatty Liver disease but also, more broadly, social determinants of health like food insufficiency and clinical trial participation.

This episode was originally suggested by Dr. Yani Adere, a Medical Science Liaison at Novo Nordisk and long-time SurfingNASH listener. Yani set the stage for this conversation by noting that while incidence of NASH and NASH cirrhosis may be relatively low among non-Hispanic Black Americans, those who get the disease progress at the same rate as other ethnic groups and, in fact, Fatty Liver is the 2nd leading cause of cirrhosis in this population. She concludes by noting that Social Determinants of Health (SDOH) create undue burdens for Black Americans with liver disease as with other diseases.

Donna Cryer, Founder and CEO of the Global Liver Institute followed Yani. First, she noted that since NASH has a limited history as a disease, it offers the chance to create history by building health equity into clinical trials and patient treatment as initial protocols and guidelines come into force, “instead of waiting 5-10 years” as with other diseases.
Dr. Zaki Sherif of Howard University raised an important point about Liver Disease in this community: while non-Hispanic Black Americans progress from liver to cirrhosis slowly (as do other groups), the speed at which they progress from cirrhosis to HCC is faster…and Black Americans are less likely and slower to receive liver transplants.
Dr. Ani Kardashian of USC, a transplant hepatologist and national leader on the issue of food insufficiency, began her comments by nothing that while Fatty Liver disease is not as common in Black Americans, outcomes are poorer. Ani raises the issue that some of the poorer outcomes might result from lower levels of patients in clinical trials, which is a challenge with many diseases.

From here, the discussion heads off in several different directions, all of which confirm the point that the intersection of relatively low incidence, other diseases with higher prevalence and severe outcomes and the range of SDOH issue leads to a situation where patients receive less treatment and support than other sub-populations. The group discusses some of the major challenges and posits possible solutions.

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