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

Authors

• Patrizia Carrieri, The Global NASH/MASH Council
• Shira Zelber-Sagi, University of Haifa
• Saleh A. AlQahtani, King Faisal Specialist Hospital and Research Center
• Khalid Alswat, King Saud University
• Yusuf Yilmaz, Recep Tayyip Erdoğan University
• Caglayan Keklikkiran, Recep Tayyip Erdoğan University
• Manuel Romero- Gómez, Virgen del Rocío University Hospital
• Jian-Gao Fan, Shanghai Jiao Tong University School of Medicine
• Ming-Hua Zheng, Wenzhou Medical University
• Mohamed El-Kassas, Capital University
• Saeed Hamid, Aga Khan UniversityFollow

Document Type

Article

Department

Medicine

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.

Comments

Volume, issue and pagination are not provided by the author/publisher.

Publication (Name of Journal)

JHEP Reports

DOI

10.1016/j.jhepr.2026.101987

Recommended Citation

Carrieri, P., Zelber-Sagi, S., AlQahtani, S. A., Alswat, K., Yilmaz, Y., Keklikkiran, C., Gómez, M. R., Fan, J., Zheng, M., El-Kassas, M., Hamid, S. (2026). Gender differences in stigma and care avoidance among people living with MASLD: An international survey. JHEP Reports.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterol/387