Health inequalities in patients with cirrhosis: Investigating the impact of material deprivation on patients’ outcomes

Abstract Background Material deprivation (MD) is a key social determinant that may influence outcomes in cirrhosis, although its effect remains underdefined. Aims To assess the impact of MD on clinical outcomes in patients with cirrhosis in a universal healthcare setting. Methods We retrospectively studied patients with cirrhosis residing in Genoa, first attending our Unit during 2016-2022, classified MD from residential address by prespecified criteria, and dichotomized MD into low and high via cluster analysis; we assessed modality of cirrhosis diagnosis, disease stage, follow-up adherence, hepatic decompensation requiring hospitalization, and overall survival. Results We studied 368 patients (68.5% male, median age 63 years), most with compensated disease (57.9%). Patients with low-MD were slightly older (64 years vs. 62 years; p<0.0001), more frequently diagnosed through screening (58.6% vs. 14.4%; p<0.001), and less likely to be lost to follow-up (8.3% vs. 15.5%; p<0.0001) compared to those with high-MD. The incidence of hepatic decompensation episodes requiring hospitalization was higher (incidence rate ratio: 1.95, CI 1.29–2.99) and overall survival was shorter (66.2 months, CI 59.6–72.7 vs. 93.7 months, CI 83.5–103.5) in patients with high-MD. Conclusion MD significantly impacts clinical outcomes in patients with cirrhosis and is associated with worse prognosis, despite universal coverage.