Gender differences in stigma and care avoidance among people living with MASLD: An international survey
JHEP Reports, cilt.8, sa.11, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 8 Sayı: 11
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.jhepr.2026.101987
- Dergi Adı: JHEP Reports
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, Directory of Open Access Journals
- Anahtar Kelimeler: Discrimination, Liver-related comorbidities, MASLD, Retention in care, Stigma
- Recep Tayyip Erdoğan Üniversitesi Adresli: Evet
Özet
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 NASH/MASH Council (GNC) among adults with a confirmed diagnosis of MASLD. The survey collected sociodemographic and clinical data and assessed perceived stigma and self-stigma using the validated Self-Stigma Scale–Short form, generating domain-specific and total scores. Severe self-stigma (simply termed 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% Southeast/Southwest Asia, and 16% Middle East and North Africa), care avoidance was more frequent among men (23.6% vs. 18.9%, p = 0.04), occurring predominantly in 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 odds ratio [OR] 1.84 [95% CI 1.07–3.18]) and self-stigma (adjusted OR 1.84 [95% CI 1.19–2.85]) were associated with care avoidance in men, whereas only perceived stigma was associated with care avoidance in women (adjusted OR 2.29 [95% CI 1.25–4.22]). In women, perceived stigma was linked to younger age, multimorbidity, and history of medical weight loss (p <0.05), whereas 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 arising from 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 necessitate that healthcare providers who treat patients with MASLD develop gender-sensitive interventions to help ensure continued engagement with the healthcare system.