S2367 Evaluating FIB-4 Performance and Equity Gaps in Liver Risk Stratification: A Retrospective Study

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common among individuals with obesity and metabolic comorbidities. The FIB-4 index is increasingly used in primary care setting as a non-invasive method for liver fibrosis risk stratification. However, its accuracy and consistency across demographic groups remain unclear. Our study therefore evaluated the associations of FIB-4 risk classification with different genders, primary languages, and races/ethnicities. Methods: We conducted a retrospective analysis of 510 adults with obesity (BMI >30) and at least 1 metabolic comorbidity seen at a primary care clinic. FIB-4 indexes were calculated and categorized using age-adjusted thresholds: for those <65 years, low risk was <1.3 and intermediate risk was 1.3-2.67; for those ≥65 years, low risk was <2.0 and intermediate risk was 2.0-2.67. High risk was defined as >2.67 for all ages. Multivariable logistic regression models were used to evaluate associations between demographic factors (gender, primary language, and race/ethnicity) and fibrosis risk categories. Results: Male patients had significantly greater odds of high-risk classification (OR = 2.72, P = 0.016). Spanish-speaking individuals were less likely to be low risk (OR = 0.25, P = 0.011) and more likely to be classified as intermediate risk (OR = 4.39, P = 0.009). Findings for Bengali and Arabic speakers were not obtainable due to small sample sizes. Despite well-established higher MASLD burden in Hispanic patients, they had significantly greater odds of low-risk classification compared to White patients (OR = 4.02, P = 0.037), with a similar but nonsignificant trend versus Black patients (OR = 3.62, P = 0.062). No significant trends were observed for Black or Asian patients. Conclusion: Higher FIB-4 indexes among men likely reflect true biological differences in fibrosis risk. Since the MASLD burden in Spanish-speaking population remains poorly characterized, their lower likelihood of low-risk classification and greater odds of intermediate risk may stem from baseline risk, language barriers that hinder care, or socioeconomic disparities. Interestingly, the low-risk classification among Hispanic patients may reflect the underutilization of fibrosis testing or the “healthy immigrant effect”. This finding also highlights potential variability in the performance of FIB-4 index across racial/ethnic groups, emphasizing the need for further validation in diverse populations to ensure equitable and accurate liver disease assessment.