(64) Higher Substance and Opioid Use Disorder in Lean Patients with MASLD

Background & Introduction: Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the leading cause of chronic liver disease. Its complex etiology combined with physiological and social factors, potentially increases vulnerability to substance use disorder (SUD), especially opioid use disorders (OUD). There is limited literature on prevalence of SUD/OUD in MASLD patients. Thus, we aim to explore the current understanding of the prevalence of OUD/SUD within an ethnically diverse population and compare between lean vs non-lean patients with MASLD.

Methods: This retrospective cohort study identified MASLD patients between January 2012 – June 2023 using ICD codes from a multi-center health network. Patients who met 1/5 cardiometabolic criteria including body mass index (BMI) > 25 (BMI >23 in Asians), hypertension, diabetes mellitus (DM), dyslipidemia, or hypertriglyceridemia were included in the study. SUD/OUD was identified via ICD codes. Demographic data including sex, age, race/ethnicity, Social Deprivation Index (SDI) and clinical characteristics were collected. The primary outcomes were prevalence of SUD/OUD and mortality. Multivariable logistic regression was conducted to determine the association of SUD/OUD among lean vs non-lean MASLD patients.

Results: Of the 59,180 MASLD patients included, the mean age (SD) was 50.9 (15.8) years, 60.1% were females and 5.1% were lean. The overall prevalence of SUD was 31.9% and OUD was 6.3%. Both SUD (38.4% vs 31.6%, p= < 0.001) and OUD (9.7% vs 6.1%, p= < 0.001) prevalence was significantly higher in lean as compared to non-lean patients. Black race (37.5%) had the highest prevalence of SUD, followed by Native Americans (33.8%), Non-Hispanic Whites (32.9%) and Hispanics (17.4%) had the least(p= < 0.001). The prevalence of OUD was highest in black race (8.2%), followed by Non-Hispanic Whites (6.8%), Native Americans (6.0%), and Hispanics (5.1%, p< 0.001). The deaths were significantly higher in patients with SUD (4.1% vs 2.1%, p= < 0.001) and OUD (6.2% vs 2.5%, p= < 0.001).
On multivariable analysis, after controlling for age, sex, SDI, smoking status, diabetes, hypertension, hyperlipidemia, and any mental disorder, the non-lean (adjusted odds ratio (aOR): 0.68, 95% Confidence Interval (CI): 0.62-0.76, p= < 0.001), and Hispanic patients (compared to Non-Hispanic Whites, aOR: 0.77, 95% CI: 0.73-0.81, p= < 0.001) have a significantly lower prevalence of SUD. OUD also had similar trends with lower prevalence in non-lean (aOR: 0.67, 95% CI: 0.59-0.77, p= < 0.001) and Hispanics (aOR: 0.86, 95% CI: 0.78-0.93, p= < 0.001). The presence of SUD (aOR: 1.41, 95% CI: 1.24-1.60, p= < 0.001) and OUD (aOR: 1.72, 95% CI: 1.45-2.04, p= < 0.001) was an independent predictor of higher mortality.

Conclusion & Discussion: There is a concerningly high prevalence of SUD/OUD among MASLD patients, with significantly higher rates observed in lean individuals and certain racial/ethnic groups. Additionally, the presence of SUD/OUD was independently associated with higher mortality. Addressing racial and ethnic disparities in SUD/OUD prevalence calls for culturally sensitive approaches and addressing underlying social inequities. Further research is warranted to explore these results and to improve health outcomes and reduce mortality in these complex patient population.

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