Differential Mortality Risk by Age in Males and Females With Steatotic Liver Disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major cause of premature mortality, but data on sex differences in mortality remain limited. We compared the overall, nonliver-related, and liver-related mortality rates per 1000 person-years in MASLD patients by sex. Propensity score matching (PSM) yielded 3579 pairs of females and males with balanced characteristics from a cohort of 8517 MASLD patients (53.1% female, 46.6% male) seen at Stanford University Medical Center (1995-2023). In the total PSM cohort, the overall (12.68 vs. 12.92), nonliver-related (11.43 vs. 11.60), and liver-related (1.25 vs. 1.32) mortality rates were similar between males and females. However, in age-stratified analyses, females had higher overall (7.99 vs. 4.95, p = 0.02) and nonliver-related (7.20 vs. 4.71, p = 0.05) mortality rates among younger (≤50 years) patients, with opposite direction among the older group with higher overall (21.40 vs. 16.51, p = 0.02) and nonliver-related (19.02 vs. 14.80, p = 0.04) mortality rates in males. In Cox regression analyses, male sex was associated with lower risks of overall and nonliver-related mortality (adjusted hazard ratio [aHR] 0.59 and 0.61) among patients ≤50 years, but with higher risks among those >50 years (aHR 1.32 and 1.30). Sex and age should be considered in the management strategies for people with MASLD.