Discrimination as a Social Determinant of Health in Autoimmune Liver Diseases: Findings from the European Reference Network on Hepatological Diseases (ERN RARE-LIVER)

Background Discrimination is a social determinant of health (SDOH) shaping development and progression of diseases. Its role in autoimmune liver diseases (AILD) is understudied. Different aspects of this dataset were previously presented at GASL 2024. Aim To identify key predictors of discrimination in patients with AILD. Methods A cross-sectional questionnaire was distributed among adults with AILD between 10/2024 and 03/2025. The survey included sociodemographics, health-related quality of life (EQ-VAS) and liver disease outcomes. Discrimination was determined by the Everyday Discrimination Scale (α=0.844; range 9 (lowest) – 45 (highest)). Linear mixed models identified key predictors of discrimination, with country of residence as a random effect. Results 1,180 individuals from 15 European countries participated: 473 with AIH, 427 with PBC, and 280 with PSC. Most were female (75.5%), aged 50–60 years. Discrimination was highest among individuals with PSC (13.1, SD 5.1) compared to AIH (12.3, SD 4.8) and PBC (11.6, SD 4.1) (p=0.000). Key predictors of discrimination were low health-related quality of life (AIH: ß=0.059, PSC: ß=0.045, PBC: ß=0.049, all p≤0.001) and young age (AIH: ß=0.575, PSC/PBC: ß=0.805, all p=0.000), while there was no association with having liver cirrhosis or liver transplantation. Discussion Young people with AILD and low health-related quality of life are at increased risk of discrimination. Since there was no link between discrimination and potentially stigmatizing end-stage liver disease, further research should identify factors contributing to discrimination in patients with AILD. Publication History Article published online: 26 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany