RESUMO
INTRODUCTION: Chronic liver disease (CLD) is associated with increased morbidity and mortality. Understanding health disparities can inform appropriate interventions. We aimed to study mortality outcomes of those with CLD by income-level (income-to-poverty ratio <5 as lower-income and > 5 as higher-income). METHODS: In this retrospective-cohort study, we analyzed data of adults from the National Health and Nutrition Examination Survey, 1999-2018. CLD included viral hepatitis, nonalcoholic fatty liver disease (NAFLD), and alcohol-associated liver disease (ALD). RESULTS: We analyzed 59,204 adults: 47,224 without CLD and 11,980 with CLD. The CLD group was older, more likely male, racial/ethnic minority groups or foreign-born, and had lower educational and income levels (P<0.001). Most (80.02%) CLD participants did not have college degrees and had lower-income (79.18%). Among CLD participants, similar differences were observed between lower and higher-income groups. Lower-income participants with CLD had significantly higher 10-year cumulative mortality compared to higher-income CLD participants (15.26% vs 8.00%, P<0.001), with consistent findings in viral hepatitis and NAFLD subgroups (P<0.001) but not ALD (P=0.71). Adjusting for age, sex, race, birthplace, lower-income CLD participants were 2.01 (HR: 2.01; 95% CI: 1.79-2.26) times more likely to die overall and in viral hepatitis (HR: 2.05; 95% CI: 1.31-3.24) and NAFLD subgroups (HR: 2.32; 95% CI: 1.69-3.18) but not ALD (HR: 1.17; 95% CI: 0.55-2.51). CONCLUSION: Lower-income, foreign-born, and racial/ethnic minority groups were disproportionately represented among those with CLD, with lower-income and CLD individuals having double the mortality risk compared to their higher-income counterparts. Interventions should be culturally appropriate and address socioeconomic barriers.