STIGMA IS A PREDICTOR OF IMPAIRMENT OF HEALTH RELATED QUALITY OF LIFE AMONG PATIENTS WITH NAFLD
Recommended Citation
Younossi ZM, Yilmaz Y, Fan J, Zheng M, Alswat KA, Alqahtani SA, El-Kassas M, Castera L, Funuyet-Salas J, Romero-Gomez M, Wong VW, Zelber-Sagi S, Treeprasertsuk S, Allen AM, Takahashi H, Kawaguchi T, Francque S, Castellanos Fernandez MI, Duseja AK, Schattenberg JM, Burra P, Carrieri MP, Arrese M, Rinella M, Singal AK, Gordon SC, Fuchs M, Eskridge W, Alkhouri N, Cusi K, Loomba R, Ranagan J, Kautz A. STIGMA IS A PREDICTOR OF IMPAIRMENT OF HEALTH RELATED QUALITY OF LIFE AMONG PATIENTS WITH NAFLD. Hepatology 2023; 78:S1768-S1774.
Document Type
Conference Proceeding
Publication Date
11-14-2023
Publication Title
Hepatology
Abstract
Background: Stigma can be associated with impairment of patients' quality-of-life. Aim: Evaluate the association between stigma and HRQL among NAFLD patients. Methods: NAFLD patients were invited to complete the Chronic Liver Disease Questionnaire- NAFLD (CLDQ-NASH; 36 items, 6 domains, range 1-7, higher scores =better HRQL) and a stigma survey about history of stigmatization or discrimination due to chronic conditions, various aspects of disease burden [Liver Disease Burden (LDB) instrument; 35 items, 7 domains including Stigma, range 1-4, higher scores = greater disease burden], and perception of various diagnostic terms. Results: The CLDQ-NASH and the stigma surveys were completed by 377 NAFLD patients (9% <35 years, 52% male, 47% with ≥ 2 chronic comorbidities, 45% type 2 diabetes, 20% severe fibrosis or cirrhosis) from 12 countries (47% USA). Of included patients, 15% reported having experienced stigma or discrimination (at least sometimes) due to their liver disease (NAFLD) and 42% due to being overweight/ obese. In addition, 26%, 35%, 23%, 25% reported feeling uncomfortable with the diagnostic terms NAFLD , fatty liver , NASH and MAFLD , respectively. All aspects of NAFLD stigma (self-reported history of stigmatization due to the liver disease of NAFLD and having LDB Stigma score in top quartile) were associated with lower HRQL scores in all domains (p ≤0.01) (Figure). In multivariate analysis adjusted for country of enrollment, history of stigmatization or discrimination due to the liver disease of NAFLD was the strongest independent predictor of lower HRQL scores in all domains (beta -0.63 to -0.92, p <0.001) while history of stigmatization due to being overweight/ obese was associated with lower Activity domain (beta =-0.36, p =0.01). Negative perception of the diagnostic terms NAFLD or NASH was not associated with HRQL scores (all p >0.05) while that of fatty liver or MAFLD was associated with impairment in Emotional, Fatigue, and Worry domains of CLDQNASH (p < 0.01). Other predictors of lower HRQL scores included female sex, lack of college education, having ≥ 2 chronic comorbidities, history of weight loss due to medical reasons, and having severe fibrosis or cirrhosis (p <0.05). Conclusion: In this survey, 15% of NAFLD patients reported having experienced stigma or discrimination due to their liver disease and this was an independent predictor of impaired HRQL. Efforts should be made to better understand and reduce the sources of stigmatization or discrimination in patients with NAFLD.
Volume
78
First Page
S1768
Last Page
S1774
