Risk of Adverse Events Differ Among Men and Women With MASLD

TOPLINE:

Women with metabolic dysfunction–associated steatotic liver disease (MASLD) have a higher risk for cirrhosis, whereas men with MASLD have elevated risks for hepatocellular carcinoma, hepatic decompensation, chronic kidney disease, cardiovascular disease, and non–sex-specific cancers.

METHODOLOGY:

MASLD represents a leading cause of liver and non-liver adverse events; however, current data on sex differences in outcomes, particularly with the updated disease concept, remain limited.
Researchers conducted a cohort study including adults with MASLD from the 2007-2022 Merative MarketScan Research Database in the United States to examine the relationship between sex and various liver and non-liver adverse events associated with the condition.
Propensity score matching was used to balance the male and female groups.
The incidence of liver adverse events (cirrhosis, hepatic decompensation, and hepatocellular carcinoma) and non-liver adverse events (cardiovascular diseases, chronic kidney disease, and non–sex-specific cancers) was compared between both sexes.
Cox proportional hazards regression and restricted mean survival time analysis were used to evaluate sex-based associations with each adverse event.

TAKEAWAY:

Researchers included 344,436 pairs of matched men and women with balanced baseline characteristics, including mean age (52.7 vs 53.0 years), mean Charlson Comorbidity Index (3.91 vs 3.91), and the prevalence of obesity (16.9% vs 16.8%), diabetes (33.2% vs 33.3%), and hypertension (62.6% vs 62.3%).
Women had higher incidence rates of any liver adverse event (12.72 vs 11.53 per 1000 person-years), with the risk for cirrhosis 9% higher in women than in men (P < .001).
Conversely, men showed a significantly higher risk for hepatocellular carcinoma (hazard ratio [HR], 2.59; P < .001) and hepatic decompensation (HR, 1.11; P < .001) than women.
Men also exhibited a higher risk for non-liver adverse events such as cardiovascular disease (HR, 1.40; P <.001), chronic kidney disease (HR, 1.16; P < .001), and non–sex-specific cancers (HR, 1.32; P < .001) than women.
At the 10-year follow-up, women with MASLD had a significantly shorter mean time to the development of cirrhosis, whereas men had a significantly shorter mean time to hepatic decompensation, hepatocellular carcinoma, cardiovascular disease, chronic kidney disease, and non–sex-specific cancers.

IN PRACTICE:

“Our study provides robust evidence of significant sex differences in the risk of both liver and non-liver adverse events in patients with MASLD to support policies for sex-based preventive, monitoring, and therapeutic management strategies of MASLD,” the authors wrote.

SOURCE:

The study, led by Taotao Yan, MD, PhD, Division of Gastroenterology and Hepatology, Stanford University Medical Center in Palo Alto, California, was published online in JAMA Network Open.

LIMITATIONS:

This study included only patients with private health insurance in the United States, necessitating additional studies to examine the association of sex in patients without insurance or with only government-sponsored insurance and patients in other world regions.

DISCLOSURES:

Data for this project were accessed using the Stanford Center for Population Health Sciences (PHS) Data Core, with the PHS Data Core being supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award. One author reported receiving research grants and personal fees from various pharmaceutical companies outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.