Inflammatory bowel disease (IBD) is associated with worse major adverse liver outcomes (MALO) in patients with chronic liver disease (CLD). Although the interplay between these conditions is recognised, the contribution of external factors such as race and socioeconomic status (SES) remains unclear. We aimed to assess the association of race and socioeconomic factors with MALO in patients with IBD and CLD.

This retrospective cohort study analysed hospitalised adults with IBD and CLD using the National Inpatient Sample database (2015–2021). Demographic variables included age, sex and race. SES included household income. Clinical variables included length of hospital stay, in-hospital mortality and comorbidities. A multivariate logistic regression analysis was performed to assess the independent associations between MALO and patient demographics, comorbidities and social determinants of health.

Among 97 628 hospitalised adult patients with IBD, 4.11% (4011/97 628) had secondary CLD. The majority of patients with IBD-CLD were white (74.94% or 2928/3907), and over half (53.83% or 2118/3934) resided in lower-income households with incomes below US$35 000. Racial disparities were evident, with significant differences in comorbidities such as sepsis, cholangitis and hepatocellular carcinoma. Among white patients, the prevalence of depression and anxiety was 20.18% (591/2928) and 24.21% (709/2928), respectively, which was higher compared with other racial groups. In adjusted analyses, African American race (OR 1.42, p=0.003) and lowest SES (OR 1.19, p=0.04) were independently associated with increased odds of MALO.

African American race and lower SES are independently associated with higher odds of MALO in patients with IBD-CLD. These findings highlight disparities that warrant further investigation and suggest that targeted interventions may help improve liver-related outcomes. Interventions reducing health inequities are desperately needed to mitigate disparities in this patient population.