S2616 Racial and Sex Disparities in Inpatient Outcomes and Comorbidity Profiles Among Patients With Alcohol-Associated Liver Disease With and Without Metabolic Syndrome: Insights From a Nationally Representative Database

Introduction: Metabolic dysfunction in alcohol-associated liver disease (ALD), termed MetALD, represents a distinct clinical phenotype. However, disparities in race and sex distribution, comorbidities, and inpatient outcomes among hospitalized ALD patients—with and without metabolic syndrome—remain underexplored. Methods: We utilized the National Inpatient Sample (2016–2021) to identify adult hospitalizations with a principal diagnosis of ALD using International Classification of Diseases, Tenth Revision (ICD-10) codes. Patients were stratified by the presence of metabolic syndrome, defined as ≥3 of the following: obesity (BMI ≥30), diabetes, hypertension, and hyperlipidemia. Demographic, clinical, and outcome variables were compared using Rao-Scott chi-square and Student’s t-tests. Multivariate regression was performed for outcomes with P < 0.1 in univariate analysis. Results: Among 936,645 weighted hospitalizations (ALD without MetS: 759,680 [81.1%]; MetS + ALD: 176,965 [18.9%]), the MetS + ALD group had a higher proportion of men (80.1% vs 67.4%, P < 0.0001) and lower representation of women (19.9% vs 32.6%, P < 0.0001). Racial differences were also significant: White patients were overrepresented in the MetS + ALD group (70.1% vs 66.7%, P = 0.0085), while patients classified as 'Other' race were underrepresented (1.8% vs 3.2%, P = 0.0053). Despite greater comorbidity burden, MetS + ALD patients had lower in-hospital mortality (3.0% vs 4.9%, P = 0.0024), with no significant differences in length of stay or total hospital charges. Conclusion: MetS + ALD is associated with notable racial and sex disparities, including underrepresentation of non-White groups and female patients. Despite these disparities and a higher metabolic comorbidity load, MetS + ALD patients demonstrated paradoxically lower inpatient mortality, suggesting that phenotype-specific factors or access-related differences may influence outcomes. These findings underscore the need for further research into the mechanisms and health equity implications of MetALD across diverse populations.