Targeted community screening in areas of high socioeconomic deprivation enhances the detection of liver fibrosis

BACKGROUND: Risk-factor-based community screening has been used to identify early liver disease. Risk-factor prevalence and liver-related outcomes are significantly affected by socioeconomic deprivation. However, the impact on targeted community screening is unknown. We evaluated the influence of deprivation on fibrosis detection within a population screening pathway. METHODS: A total of 1613 patients were assessed using 2 pathways: Proactive case finding at 7 primary care practices (PCPs) and a comparator standard-of-care pathway. Individuals with specific risk factors were identified: obesity (BMI >30 kg/m2), type 2 diabetes, alcohol consumption >400/>280 g/week in males/females, respectively, coding for steatosis and ALT >50/>35 IU/mL in males/females, respectively. Liver stiffness measurement (LSM) ≥8.0 kPa was used to determine fibrosis, and the Index of Multiple Deprivation (IMD) was used to determine deprivation at the individual and neighborhood level. RESULTS: In all, 325 (20.1%) patients had LSM ≥8.0 kPa. Fibrosis detection increased with the number of risk factors [2: OR 2.47 (p=0.027, 95% CI 1.11-5.50), 3: OR 5.19 (p <0.001, 95% CI 2.34-11.53), 4: OR 10.19 (p <0.001, 95% CI 4.44-23.40), 5: OR 23.40 (p <0.001, 95% CI 6.15-89.04)]. Patients with a low IMD score (<10) had significantly lower median LSMs than those with a high IMD score (>50) [5.4 kPa vs. 6.0 kPa (p=0.0005)]. In the proactive case finding pathway, obesity prevalence was higher in PCPs in areas of high deprivation [83.5% vs. 65.6% (p=0.003)]. Fibrosis detection was significantly higher in PCPs situated in neighborhoods with high socioeconomic deprivation compared with low deprivation [27.0% vs. 8.6% (p=0.028)]. CONCLUSION: Liver fibrosis detection was disproportionately higher in neighborhoods with greater socioeconomic deprivation. Screening strategies targeting areas with higher deprivation could increase the diagnostic yield of advanced fibrosis.