Global Co‐Occurrence Patterns of Ischemic Heart Disease and Metabolic Dysfunction–Associated Steatotic Liver Disease: Spatial Clusters, Risk Factors, and Quality‐of‐Care Index

BACKGROUND: Ischemic heart disease and metabolic dysfunction-associated steatotic liver disease represent significant global health challenges, characterized by overlapping pathophysiological mechanisms. A comprehensive understanding of their spatial co-occurrence, common risk factors, and disparities in health care quality is essential for the development of integrated prevention and treatment strategies. METHODS: Using data from the 2021 GBD (Global Burden of Disease) study, encompassing 204 countries and territories, we conducted an analysis of the spatial co-occurrence patterns of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease. To identify principal risk factors, we used machine learning techniques, specifically Shapley Additive Explanations, alongside negative binomial regression models. Furthermore, the Quality-of-Care Index was computed to assess the alignment of health care services with the disease burden. RESULTS: A notable spatial co-occurrence of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease was identified, especially prevalent in regions such as the Middle East, North Africa, and emerging economies. The primary shared risk factors encompassed kidney dysfunction, high body mass index, and ambient particulate matter pollution. Disparities in the Quality-of-Care Index were apparent, with regions including Eastern Europe, South Asia, and certain areas of Africa exhibiting insufficient health care resources in comparison with the burden of disease. CONCLUSIONS: The comorbidity of ischemic heart disease and metabolic dysfunction-associated steatotic liver disease constitutes a significant global health concern. Implementing comprehensive interventions aimed at addressing risk factors has the potential to mitigate the worldwide burden of cardiometabolic diseases.