System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 42686023 DOI: 10.1016/j.jhepr.2026.101987

Gender differences in stigma and care avoidance among people living with MASLD: an international survey.

JHEP Rep

Authors: Patrizia Carrieri, Shira Zelber-Sagi, Saleh A AlQahtani, Khalid Alswat, Yusuf Yilmaz, Caglayan Keklikkiran, Manuel Romero-Gómez, Jian-Gao Fan, Ming-Hua Zheng, Mohamed El-Kassas, Laurent Castera, Chun-Jen Liu, Vincent Wai-Sun Wong, Sombat Treeprasertsuk, Saeed Hameed, Hirokazu Takahashi, Takumi Kawaguchi, Ajay Duseja, Sven Francque, C Wendy Spearman, Marlen I Castellanos Fernández, Patrizia Burra, Stuart K Roberts, Wah-Kheong Chan, Marco Arrese, Ashwani K Singal, Stuart Gordon, Michael Fuchs, Naim Alkhouri, Rohit Loomba, Jane Ranagan, Janus P Ong, Yuichiro Eguchi, Moises Diago, Ming-Lung Yu, Brian Lam, Lynn Gerber, Dana Ivankovsky-Wajcam, Linda Henry, Maria Stepanova, Zobair M Younossi

Affiliations

  • The Global NASH/MASH Council, Washington DC, United States; Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
  • The Global NASH/MASH Council, Washington DC, United States; School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
  • The Global NASH/MASH Council, Washington DC, United States; Liver, Digestive, and Lifestyle Health Research Section, and Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • The Global NASH/MASH Council, Washington DC, United States; Liver Disease Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Gastroenterology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
  • The Global NASH/MASH Council, Washington DC, United States; UCM Digestive Diseases and ciberehd, Virgen del Rocío University Hospital, Instituto de Biomedicina de Sevilla (HUVR/CSIC/US), Department of Medicine, University of Seville, Seville, Spain.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Gastroenterology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  • The Global NASH/MASH Council, Washington DC, United States; MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • The Global NASH/MASH Council, Washington DC, United States; Endemic Medicine Department, Faculty of Medicine, Capital University (Formerly Helwan University), Cairo, Egypt.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Hepatology, Beaujon Hospital, AP-HP, Université Paris Cité, Inserm UMR1149, Clichy, France.
  • The Global NASH/MASH Council, Washington DC, United States; Hepatitis Research Center, Department of Internal Medicine and Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
  • The Global NASH/MASH Council, Washington DC, United States; Division of Gastroenterology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Medicine, Clinical Trials Unit, Aga Khan University, Karachi, Pakistan.
  • The Global NASH/MASH Council, Washington DC, United States; Liver Center, Saga University Hospital, Saga, Japan.
  • The Global NASH/MASH Council, Washington DC, United States; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
  • The Global NASH/MASH Council, Washington DC, United States; Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
  • The Global NASH/MASH Council, Washington DC, United States; Institute of Gastroenterology, University of Medical Sciences of Havana, Havana, Cuba.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Gastroenterology, Padua University Hospital, Padua, Italy.
  • The Global NASH/MASH Council, Washington DC, United States; The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
  • The Global NASH/MASH Council, Washington DC, United States; Gastroenterology and Hepatology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
  • The Global NASH/MASH Council, Washington DC, United States; Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
  • The Global NASH/MASH Council, Washington DC, United States; Division of Gastroenterology and Hepatology, University of Louisville School of Medicine, Trager Transplant Center and Jewish Hospital, Louisville, KY, USA.
  • The Global NASH/MASH Council, Washington DC, United States; Department of Hepatology and Gastroenterology, Henry Ford Hospital System, Detroit, MI, USA.
  • The Global NASH/MASH Council, Washington DC, United States; Central Virginia VA Health Care System (CVHCS), Virginia Commonwealth University (VCU), Richmond, VA, USA.
  • The Global NASH/MASH Council, Washington DC, United States; Summit Clinical Research, San Antonio, Texas, United States.
  • The Global NASH/MASH Council, Washington DC, United States; Division of Gastroenterology, University of California, San Diego, San Diego, CA, USA.
  • The Global NASH/MASH Council, Washington DC, United States; Chronic Liver Disease Foundation, Clark, NJ, USA.
  • The Global NASH/MASH Council, Washington DC, United States; College of Medicine, University of the Philippines, Manila, Philippines.
  • The Global NASH/MASH Council, Washington DC, United States; Loco Medical General Institute, Saga University Faculty of Medicine, Saga, Japan.
  • The Global NASH/MASH Council, Washington DC, United States; Hospital Quiron Salud ,Valencia, Spain.
  • The Global NASH/MASH Council, Washington DC, United States; Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine and Center of Metabolic Disorders and Obesity, Kaohsiung Medical University, Kaohsiung, Taiwan.
  • The Global NASH/MASH Council, Washington DC, United States; Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
  • The Global NASH/MASH Council, Washington DC, United States.
  • The Global NASH/MASH Council, Washington DC, United States; Center for Outcomes Research in Liver Diseases, Washington, DC, USA.

Abstract

BACKGROUND & AIMS

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects women and men differently, and both perceived and self-stigma may contribute to care avoidance. This study aimed to assess gender-specific patterns of stigma and their associations with care avoidance in MASLD.

METHODS

A cross-sectional, international survey was administered in 2023 by the Global MASH/NASH Council (GNC) among adults with a confirmed diagnosis of MASLD. The survey collected sociodemographic and clinical data, assessed perceived stigma and self-stigma using the validated Self-Stigma Scale-Short Form, generating domain-specific and total scores. Severe self-stigma (simply named self-stigma) was defined as a total score above the 75th percentile, stratified by gender. Care avoidance in primary or secondary care (gastroenterology, hepatology, and endocrinology) was reported.

RESULTS

Among 1,313 respondents with MASLD (51% men; 50% aged ≥55 years; 28% Europe, 26% USA/Canada, 30% South East/West Asia, 16% MENA), care avoidance was more frequent among men (23.6% vs. 18.9%, p=0.04), occurring predominantly in the primary care. Women reported higher self-stigma scores (all p<0.001) and more discrimination-related perceived stigma (27.8% vs. 19.1%). In adjusted analyses, both perceived stigma [adjusted OR(95%CI): 1.84(1.07-3.18)] and self-stigma [1.84(1.19-2.85)] were associated with care avoidance in men, whereas only perceived stigma was associated with care avoidance in women [2.29(1.25-4.22)]. In women, perceived stigma was linked to younger age, multimorbidity, and history of medical weight loss (p<0.05), while no predictors were identified in men. Lower socioeconomic status and advanced fibrosis predicted self-stigma in both genders.

CONCLUSIONS

Stigma emerges as a major, gender-specific barrier to care in MASLD, with distinct mechanisms in men and women. Integrating gender-sensitive, stigma-informed strategies into MASLD care may improve access and continuity of care.

IMPACT AND IMPLICATIONS

The presence of stigma due to liver disease is associated with avoiding care. However, despite women reporting a higher degree of stigma than men, men more often avoided healthcare visits especially when self-stigma was present. These differences in stigma and care avoidance by gender necessitates that healthcare providers who treat patients with MASLD develop gender-sensitive interventions to help ensure continued engagement with the healthcare system.

MeSH

Liver Diseases, Non-Alcoholic Fatty Liver Disease, Liver, Retention In Care, Sex Characteristics, Sex Differences