Socioeconomic, Environmental Disadvantage Linked to Pediatric MASLD Risk – HCPLive

Report on the Association Between Social Determinants and Pediatric Liver Disease in the Context of Sustainable Development Goals

1.0 Executive Summary

A recent cross-sectional study establishes a significant link between adverse social determinants of health (SDH) and the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) among children with overweight or obesity. The findings indicate that children with MASLD are disproportionately from neighborhoods characterized by socioeconomic and environmental disadvantages. This report analyzes these findings, highlighting their direct implications for several United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 11 (Sustainable Cities and Communities).

2.0 Study Overview and Methodology

The research aimed to assess the association between neighborhood-level SDH and MASLD in children under 18 residing in California. The study cohort was stratified into two groups:

• Case Group: 593 children with overweight or obesity and a biopsy-confirmed MASLD diagnosis.
• Control Group: 295 children with overweight or obesity but without MASLD, confirmed via normal liver enzymes and imaging.

Neighborhood-level SDH were quantified using the California Healthy Places Index (HPI) 3.0, which measures socioeconomic and environmental conditions across various domains.

3.0 Key Findings and Disparities

The study identified significant disparities between the two groups, underscoring the role of socioeconomic factors in health outcomes.

1. Demographic Differences: The MASLD group had a higher proportion of males (65.9% vs. 56.9%) and children identifying as Hispanic (80.8% vs. 65.8%) compared to the control group.
2. Socioeconomic Disadvantage: Children with MASLD resided in neighborhoods with significantly lower HPI scores, corresponding to the 41st percentile, compared to the control group’s neighborhoods, which were near the 49th percentile.
3. Specific Environmental and Social Factors: The MASLD group was more likely to live in areas with disadvantages across multiple HPI subdomains, including:
   • Economic resources
   • Housing conditions
   • Neighborhood safety and environment
   • Social support networks
   • Healthcare access

4.0 Alignment with Sustainable Development Goals (SDGs)

The study’s findings provide critical evidence on the interconnectedness of health, environment, and social equity, directly aligning with the 2030 Agenda for Sustainable Development.

4.1 SDG 3: Good Health and Well-being

MASLD is the leading cause of pediatric liver disease. The study demonstrates that achieving good health for all children (Target 3.4) is contingent not only on clinical care but also on addressing the underlying social and environmental conditions that drive non-communicable diseases. The prevalence of MASLD in disadvantaged communities highlights a failure to ensure equitable health outcomes.

4.2 SDG 10: Reduced Inequalities

The research is a clear illustration of health inequalities (Target 10.2). The disproportionate impact of MASLD on children from specific ethnic groups (Hispanic) and low-income neighborhoods underscores the need for policies that reduce inequality. The data show that a child’s risk for a serious liver condition is linked to their zip code, a stark indicator of systemic inequality.

• Lower economic, social, and education scores were associated with poorer liver health markers (AST and ALT levels).
• This reinforces the necessity of targeting interventions to empower and promote the social and economic inclusion of all, irrespective of origin or economic status.

4.3 SDG 11: Sustainable Cities and Communities

The report links MASLD risk to adverse neighborhood conditions, including poor housing and greater environmental risks such as air pollution. This directly relates to the goal of creating safe, resilient, and sustainable human settlements (Target 11.6). Improving public health requires a focus on creating healthy living environments with access to safe housing and reduced environmental pollution.

5.0 Conclusion and Recommendations

This study confirms that socioeconomic and environmental factors are significant contributors to MASLD risk in children. The findings present a compelling case for integrating public health strategies with broader social and urban development policies to achieve the Sustainable Development Goals.

Future actions should include:

1. Developing targeted public health interventions for at-risk communities to mitigate the impact of adverse SDH on pediatric health.
2. Conducting longitudinal studies to understand the long-term influence of specific SDH factors on MASLD progression.
3. Implementing cross-sectoral policies that address poverty (SDG 1), education (SDG 4), and environmental justice (SDG 11) as fundamental components of a comprehensive public health strategy.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s central theme is the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in children, a significant non-communicable disease. It states that “MASLD is the leading cause of liver disease among children,” directly addressing the goal of ensuring healthy lives.
2. SDG 10: Reduced Inequalities
   • The research explicitly links health outcomes to socioeconomic and racial disparities. It finds that children with MASLD are more likely to be from disadvantaged neighborhoods and specific ethnic groups, noting that “children in the MASLD group being more likely to identify as Hispanic (80.8% vs 65.8%) and less likely to identify as White (20.7% vs 44.1%).” This highlights inequality in health outcomes based on socioeconomic status and ethnicity.
3. SDG 1: No Poverty
   • The study identifies “lower socioeconomic advantage” and “reduced access to… economic resources” as key factors associated with MASLD. This connects the health issue directly to economic disadvantage and poverty, which are the focus of SDG 1.
4. SDG 11: Sustainable Cities and Communities
   • The article emphasizes the role of neighborhood conditions, citing “poorer housing conditions, and greater environmental risks, including higher air pollution exposure” as factors linked to MASLD. This directly relates to the goal of making cities and human settlements inclusive, safe, resilient, and sustainable.
5. SDG 4: Quality Education
   • The analysis points to “reduced access to education” as a characteristic of the neighborhoods where children with MASLD are more likely to reside. This links the health disparity to educational inequality, a core component of SDG 4.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: Reduce premature mortality from non-communicable diseases
   • The article focuses on MASLD, a non-communicable disease, in children. By investigating its social and environmental risk factors, the research aims to inform “strategies for early intervention and risk mitigation,” which is essential for preventing the long-term consequences of the disease and reducing premature mortality.
2. Target 10.2: Promote the social and economic inclusion of all, irrespective of race, ethnicity or economic status
   • The study’s findings demonstrate a lack of inclusion and equal health outcomes. It shows that children from neighborhoods with “lower socioeconomic advantage” and those of Hispanic ethnicity are disproportionately affected by MASLD, indicating that social and economic status are barriers to good health.
3. Target 11.1: Ensure access for all to adequate, safe and affordable housing
   • The research identifies “poorer housing conditions” as a significant factor in neighborhoods where children with MASLD live. This directly connects the lack of adequate housing to negative health outcomes, aligning with the objective of this target.
4. Target 11.6: Reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality
   • The article explicitly mentions that affected children are more likely to live in areas with “greater environmental risks, including higher air pollution exposure.” This highlights the direct health impact of poor urban environmental quality, which this target aims to address.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. California Healthy Places Index (HPI) 3.0 Score
   • This is a direct indicator used in the study to quantify neighborhood-level disadvantage. The article provides specific values, stating that children with MASLD had a “mean HPI of −0.22±0.43, corresponding to roughly the 41st percentile,” which serves as a measurable indicator of socioeconomic conditions.
2. HPI Subdomain Scores
   • The article breaks down the HPI into specific domains, which act as granular indicators. It mentions that children with MASLD lived in neighborhoods with lower scores in the “economic,” “housing,” “neighborhood,” “social,” and “healthcare access” domains, providing specific metrics to track progress in these areas.
3. Prevalence of MASLD in Children
   • The rate of MASLD diagnosis within the study cohort (“593 children with overweight or obesity were diagnosed with MASLD”) is a direct health outcome indicator that can be used to measure the burden of this non-communicable disease.
4. Data on Health Disparities by Race and Ethnicity
   • The article provides specific statistics on the ethnic distribution of children with and without MASLD (e.g., “Hispanic (80.8% vs 65.8%)”). This data serves as a direct indicator for measuring health inequality among different population groups.
5. Measures of Air Pollution Exposure
   • The article implies the use of this indicator by stating that affected children face “greater environmental risks, including higher air pollution exposure.” Measuring air quality levels in different neighborhoods would be a direct indicator for Target 11.6.

SDGs, Targets, and Indicators Table

Source: hcplive.com