Global Sociodemographic Disparities in the Severity of Alcohol-Associated Hepatitis

Introduction and objectives Alcohol-associated hepatitis (AH) carries high short-term mortality, yet the contribution of sociodemographic factors to disease severity and outcomes is poorly defined. Patients and Methods We conducted a prospective cohort study across 30 centers in 14 countries (January 2015–September 2024). We included adults who met National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for AH. Outcomes included infections, access to liver transplantation (LT), and survival. Mortality was analyzed with Fine-Gray competing-risk models. Results Among 726 participants (median age, 49 years; 90.1% male), 24.8% had less than secondary education, and 37.6% reported good social support. Severe AH was more frequent in those without secondary education than in those with at least secondary education (97.2% vs. 81.7%; P<0.0001). The 30- and 90-day survival rates were lower among participants without secondary education (66.4% and 50.4%, respectively) than among those with at least secondary education (88.4% and 81.2%, respectively). In adjusted analyses, moderate and good social support were associated with lower mortality (each sHR 0.58, 95% CI, 0.38–0.89 and 0.38–0.94, respectively), as were secondary (sHR 0.48, 95% CI, 0.24–0.97) and tertiary education (sHR 0.44, 95% CI, 0.20–0.97) and corticosteroid use (sHR 0.63, 95% CI, 0.42–0.95). Conclusions Lower educational attainment and poorer perceived social support were associated with greater AH severity at presentation and higher mortality, independent of clinical risk factors. These findings highlight the need to address social determinants and favor equitable access to evidence-based therapies, including early LT.