Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2024; 15(5): 886-897
Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.886
Disparate outcomes in Hispanic patients with metabolic dysfunction-associated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study
Joseph Matthew Gosnell, George Golovko, Esteban Arroyave, Akshata Moghe, Michael L Kueht, Omar Abdul Saldarriaga, Kevin H McKinney, Heather L Stevenson, Monique R Ferguson
Joseph Matthew Gosnell, Esteban Arroyave, Heather L Stevenson, Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, United States
George Golovko, Department of Pharmacology & Toxicology, University of Texas Medical Branch, Galveston, TX 77555, United States
Akshata Moghe, Department of Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Michael L Kueht, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, United States
Omar Abdul Saldarriaga, Center for Tropical Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
Kevin H McKinney, Monique R Ferguson, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
Co-corresponding authors: Joseph Matthew Gosnell and Monique R Ferguson.
Author contributions: Gosnell JM and Ferguson MR contributed equally to this publication and are co-corresponding authors. Gosnell JM, Moghe A, Stevenson HL, and Ferguson MR conceptualized the study; Gosnell JM, Golovko G, and Ferguson MR constructed the research methodology, and were responsible for study and result validation; Golovko G was responsible for software optimization, provided resources and data curation via TriNetX, and assisted in securing funding; Gosnell JM, Golovko G, Arroyave E, and Ferguson MR performed the formal analysis and worked on data/result visualization; Gosnell JM and Ferguson MR performed investigation of results, and were responsible for supervising the manuscript; Gosnell JM, Arroyave E, and Ferguson MR wrote the original draft; Gosnell JM, Golovko G, Arroyave E, Moghe A, Kueht ML, Saldarriaga OA, McKinney KH, Stevenson HL, and Ferguson, MR assisted in reviewing and editing the manuscript; Gosnell JM, Stevenson HL, and Ferguson MR administrated the project.
Supported by Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a Clinical and Translational Science Award from the National Center for Advancing Translational Sciences at the National Institutes of Health, UL1TR001439; and Moody Endowment Grant, 2014-07.
Institutional review board statement: DATE: August 23, 2023 TO: UTMB Researcher FROM: Anne Clark, BA, CIP Director, Human Research Protection Program RE: IRB Acknowledgement of Not Human Subject Research Title: Secondary Analysis of data from TriNetX Utilization of data from the TriNetX database UTMB IRB 20-0085 titled Deidentified Collections of Electronical Medical Records For Internal(I2B2) and External (TriNetX) Access does not require UTMB IRB review as it is secondary analysis of existing data, does not involve intervention or interaction with human subjects an is de-identified per the de-identification standard defined in Section 164.512(a) of the HPAA Privacy Rule. The process by which the data is de-identified is attested to through a formal determination by a qualified expert as defined in Section 164.514(b)(1). Therefore, the data does not meet the definition of a human subject as outlined at 45 CFR 46.102 and is deemed not human subject research which does not require IRB review and/or approval. If you have any questions related to this project or the IRB, you may telephone me, at 409-266-9434.
Informed consent statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding authors at jogosnel@utmb.edu or mrfergus@utmb.edu.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph Matthew Gosnell, MD, MS, Doctor, Department of Pathology, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States. jogosnel@utmb.edu
Received: December 12, 2023
Peer-review started: December 12, 2023
First decision: December 25, 2023
Revised: January 9, 2024
Accepted: March 6, 2024
Article in press: March 6, 2024
Published online: May 15, 2024
Processing time: 149 Days and 13.1 Hours
ARTICLE HIGHLIGHTS
Research background

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are part of a growing health burden across the globe with disparate rates and outcomes between ethnic groups within the United States. While these disparities have been presented in the context of specific geographic sub-regions of the United States, no comparison has been made to determine whether these effects are truly geographically limited within the United States via a large cohort study.

Research motivation

To determine if disparities in outcomes associated with MASLD/MASH in Hispanic patient populations were geographically determined or if consistent amongst a United States national cohort of patients.

Research objectives

Given the inclusion of University of Texas Medical Branch (UTMB) within the well-studied Southeast Texas sub-region and the disparity of outcomes experienced by Hispanic patients within this region, we set out to determine if this effect was comparable in the wider United States cohort available through the TriNetX platform.

Research methods

Data collection was performed exclusively through the TriNetX database system, a global federated healthcare research network with formation of two cohorts, a UTMB-only cohort and a United States national cohort. Selection was made for those diagnosed with MASH and further subdivided into those who identified as Hispanic vs non-Hispanic.

Research results

Disparities are seen in outcomes such as rates of liver fibrosis/cirrhosis, incidence of hepatocellular carcinoma, all-cause mortality, and rates of type 2 diabetes mellitus (T2DM) within the national and UTMB Hispanic cohorts when compared to the non-Hispanic cohorts, while all-cause mortality in the US cohort was lower in Hispanic/Latino patients and . all-cause mortality within the UTMB cohort was not statistically significant.

Research conclusions

Hispanic patients do have disparity of outcomes associated with MASLD/MASH, especially in connection with rates of T2DM. This disparity is not limited to a single geographic location, like Southeast Texas, but is observed in the United States national population cohort also.

Research perspectives

Next step, we will investigate whether cardiometabolic criteria or risk factors as listed in the 2023 American Association for the Study of Liver Diseases guidelines occur with greater frequency in the Southeast Texas Hispanic population in comparison to other ethnic groups and whether this offers a possible explanation for the disparity in outcomes observed in similar studies.