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

ABSTRACT 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.