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Life sciences · Journal article
Frontiers in Endocrinology · September 30, 2026
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Background Socioeconomic disadvantage and ambient air pollution are each associated with adverse liver and metabolic health. We examined their joint associations with liver-related and metabolic outcomes among middle-aged and older women. Methods This multi-database observational study included UK Biobank women and US women aged 40 years or older. UK exposures were Townsend deprivation and a residential 2010 PM 2.5 –NO 2 score; outcomes were calculated Fatty Liver Index (FLI), FLI-defined probable fatty liver, and MRI liver fat. The contextual UK main model jointly included air pollution, Townsend deprivation, age, and collapsed ethnicity; extended sensitivity models additionally included smoking, alcohol frequency, education, and walking pace. US exposures were state poverty and PM 2.5, and the primary outcome was age-standardized obesity prevalence. Results Among 231,525 UK women, mean FLI was 38.19 and 25.79% had FLI ≥60. In the contextual UK main model, Townsend deprivation was associated with higher FLI [β = 1.114, 95% confidence interval (CI) 1.069 to 1.159] and higher odds of FLI ≥60 [odds ratio (OR) 1.080, 95% CI 1.076 to 1.084]. The positive age-adjusted pollution associations were attenuated after Townsend adjustment (FLI β = −0.068, 95% CI −0.137 to 0.001; FLI ≥60 OR 0.999, 95% CI 0.993 to 1.004). Across 46 US jurisdictions, each one standard deviation higher poverty level was associated with 1.38 percentage points higher female obesity prevalence after PM 2.5 and regional adjustment (95% CI 0.58 to 2.17). Conclusion Socioeconomic disadvantage was consistently associated with poorer liver-related and metabolic health among middle-aged and older women. In contrast, the UK pollution–FLI association was not supported after concurrent adjustment for area deprivation. Social conditions and environmental exposures should be considered jointly when assessing metabolic health in women.