Socioeconomic Status, Clinical Characteristics and Mortality in Two Subtypes of ALD According to the New SLD Classifications

Abstract

Under the new steatotic liver disease (SLD) framework, alcohol-related liver disease (ALD) is defined including two subtypes: (1) people with cardiometabolic risk factors (CMRFs) and with alcohol consumption > 50/60 g/day (for female/male), noted as ALD-1, and (2) people with daily alcohol consumption > 20/30 g/day but without CMRF, noted as ALD-2. However, little is known about the difference between these subtypes. Using UK biobank data, we identified individuals with ALD-1 and ALD-2 using the standard definition. We compared the two groups on their socioeconomic status, clinical characteristics, and mortality. Among 11 583 participants with ALD, only 17 (0.15%) had ALD-2. Compared to ALD-1, those with ALD-2 were more likely to be non-White, socioeconomically deprived, and smokers, with higher levels of ALT, AST, GGT, and FIB4 scores. The mortality rate was significantly higher in ALD-2 than ALD-1 (31.9 vs. 11.3 per 1000 person-years, HR 2.45 (95% CI 1.09, 5.50)). ALD-1 and ALD-2 exhibit substantial heterogeneity in socioeconomic status, lifestyle factors, clinical characteristics, and prognoses, suggesting distinct underlying mechanisms. These findings highlight the need for tailored management strategies that address the unique characteristics of each subtype.