Real-world work productivity is impaired in people with metabolic dysfunction-associated steatotic liver disease in the USA

Abstract

Background & Aims

The impact of metabolic dysfunction-associated steatohepatitis (MASH) on patient-reported outcomes is poorly understood. We assessed work productivity burden in a real-world population with suspected/confirmed MASH, comparing work productivity and symptoms across subgroups (risk status, age, BMI, and comorbidities) in the USA using secondary data from Adelphi Real World MASH Disease Specific Programmes™, cross-sectional surveys of physicians and consulting patients in 2019 and 2022.

Methods

Physicians (hepatologists, gastroenterologists, and endocrinologists) reported sociodemographic data and signs/symptoms for eight or fewer consecutive participants with MASH. Participants voluntarily completing questionnaires that assessed work productivity, health status, and quality of life/symptoms were categorized with low-, indeterminate-, or high-risk MASH using physician-stated fibrosis stage and derived risk categories. Principal components factor analysis identified factors from MASH signs and symptoms. Elastic net regression determined features associated with work productivity impairment.

Results

In total, 87 physicians and 429 individuals with MASH provided data. The impact of MASH on activities was greater in high-versus low-risk MASH (activity impairment score: high risk, 30.8%; low risk, 17%; p <0.001 across all risk categories). Overall work impairment scores were 18.8% in low-risk and 19.9% in high-risk MASH. Of the 14 physician-reported signs/symptoms, 11 were significantly associated with physician-stated fibrosis stage and/or derived risk category. Two clusters of signs and symptoms (‘memory loss/swelling legs/abdomen’ and ‘fatigue/sleep disturbance/insomnia/general weakness’) and female sex were the strongest work impact predictors.

Conclusions

Activity impairment was greater in participants with high-risk MASH, whereas overall work impairment was comparable, almost 20%, in low- and high-risk MASH. Non-specific symptoms of fatigue, sleep disturbance, and general weakness associated with MASH and other conditions predicted work impact in low-risk MASH. Thus, early detection and management of MASH could ameliorate work impairment.

Impact and implications

Even in its early stages, when otherwise asymptomatic, metabolic dysfunction-associated steatohepatitis (MASH) may impact the ability to work. Using the Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) questionnaire, we identified activity and overall work impairment in people with high- and low-risk MASH. We found a link between difficulty working and other signs, such as tiredness, sleep disturbance, and general weakness, in low-risk MASH that are not specific to MASH but can be associated with liver health. These general, non-specific signs could represent possible early warning signs preceding reduced productivity in patients with MASH.