County-Level Factors and Preventable Premature Liver Mortality in Metabolic Dysfunction–Associated Steatotic Liver Disease

What county-level factors are associated with the proportion of preventable premature liver mortality from metabolic dysfunction–associated steatotic liver disease (MASLD-PLM) in the US?In this cross-sectional study of 2704 US counties from 2011 to 2020, an estimated 44.1% to 58.0% of MASLD-PLM cases were considered preventable, depending on the benchmark applied, and higher percentages of MASLD-PLM were associated with greater rurality; increased rates of physical inactivity, obesity, and diabetes; and preventable hospitalizations. These patterns were further associated with upstream factors such as limited access to exercise-friendly environments, poor food environments, and higher rates of uninsurance.In this study, most MASLD-PLM in the US was estimated to be preventable, and findings identified multiple upstream socioeconomic, health care, environmental, and behavioral factors that may warrant further evaluation in future research and intervention studies.

Corresponding Author: Zobair M. Younossi, MD, MPH, The Global NASH Council, 2411 I St, Washington, DC 20037 (zobair.younossi@cldq.org).

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