Gender differences in stigma and care avoidance among people living with MASLD: An international survey
Recommended Citation
Carrieri P, Zelber-Sagi S, AlQahtani SA, Alswat K, Yilmaz Y, Keklikkiran C, Romero-Gómez M, Fan JG, Zheng MH, El-Kassas M, Castera L, Liu CJ, Wai-Sun Wong V, Treeprasertsuk S, Hameed S, Takahashi H, Kawaguchi T, Duseja A, Francque S, Spearman CW, Castellanos Fernández MI, Burra P, Roberts SK, Chan WK, Arrese M, Singal AK, Gordon S, Fuchs M, Alkhouri N, Loomba R, Ranagan J, Ong JP, Eguchi Y, Diago M, Yu ML, Lam B, Gerber L, Ivankovsky-Wajcam D, Henry L, Stepanova M, Younossi ZM. Gender Differences in Stigma and Care Avoidance among People Living with MASLD: An International Survey. JHEP Rep. 2026;8(11):101987.
Document Type
Article
Publication Date
9-2-2026
Publication Title
JHEP Rep
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 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.
PubMed ID
42686023
Volume
8
Issue
11
First Page
101987
Last Page
101987
