The MASLD Journey in the General Population: Linkage-to-Care and Patient-Reported Uptake of Fibrosis Risk Assessment

Despite the growing burden of steatotic liver disease (SLD), real-world evidence on patient-reported post-diagnostic care pathways and fibrosis risk assessment remains limited. We aimed to describe the patient-reported care pathway from initial diagnosis to subsequent follow-up and fibrosis assessment among individuals with self-reported SLD, including those meeting at-risk criteria in a population-based survey sample.

A web-based survey was conducted among Korean adults aged ≥ 19 years recruited from an established online research panel, using quota strata to approximate the national distribution of key demographics. Respondents completed a screening questionnaire; those who screened positive for self-reported physician-diagnosed or imaging-detected fatty liver/SLD proceeded to the full survey on post-diagnosis healthcare utilization and follow-up. Of 12 946 respondents with a valid screening questionnaire, 1000 individuals with self-reported SLD comprised the final analytic sample.

The self-reported prevalence of physician-diagnosed or imaging-detected SLD was 23.7%. Most participants (79.9%) reported an incidental diagnosis during routine medical check-ups. Overall, 57.7% (577/1000) reported linkage-to-care, and 14.9% (86/577) of those reporting linkage-to-care also reported having undergone fibrosis assessment. Among those reporting no follow-up, the most commonly cited reason was the belief that SLD was not a serious condition. Among those reporting linkage-to-care, 68.8% (397/577) reported follow-up in primary clinics and 31.2% (180/577) in referral centres; patient-reported fibrosis assessment was 10.6% (42/397) and 24.4% (44/180), respectively. The at-risk subgroup comprised 61.9% (619/1000); 65.6% (406/619) reported linkage-to-care and 12.1% (75/619) reported fibrosis assessment. Patient-reported linkage-to-care was 55.5% in MASLD, 59.7% in MetALD and 65.2% in ALD.

In this survey sample, most respondents with self-reported SLD reported an incidental diagnosis during medical check-ups, and patient-reported fibrosis assessment was uncommon, including among those meeting at-risk criteria.