Poor Access to MASLD Care for Most US Patients

 In the US, 82.4% of counties lacked an advanced diagnostic unit for elastography imaging, 69.2% lacked access to a practicing gastroenterologist, and 67.4% lacked both resources, resulting in significant geographic gaps in screening and care for metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODOLOGY

• Access to transient elastography, magnetic resonance elastography, and gastroenterologists is essential for primary care providers to follow recommended screening pathways for patients at risk for MASLD and advanced liver fibrosis.
• Researchers analyzed public data collected in July 2025 from the manufacturer’s website of each diagnostic test to identify the number of transient elastography and magnetic resonance elastography units across the US; they used public data from the Health Resources and Services Administration to quantify the number of practicing US county-level gastroenterologists in 2022 with an MD degree.
• A total of 3143 census-designated counties were analyzed for the availability of elastography units and gastroenterologists, using population data obtained from the US Census Bureau for the year 2020.
• Researchers calculated the density of elastography units and gastroenterologists per capita and per 100,000 adults with MASLD at the state and national levels.
• The analysis estimated the time required to screen all 15.1 million US adults with MASLD and a Fibrosis-4 score ≥ 1.3, assuming each scan would run for 15 minutes and be performed consecutively for 40 hours per week.

TAKEAWAY

• In the US, 2421 elastography units and 15,774 practicing gastroenterologists were identified; however, 82.4% of the counties did not have access to an elastography unit, 69.2% did not have a gastroenterologist, and 67.4% did not have either resource. Only 15.7% of the counties had both an elastography unit and a gastroenterologist.
• Nationally, only 7.3 elastography units per 1 million residents and 2.9 units per 100,000 adults with MASLD were available, translating to 1 unit for every 34,677 adults with MASLD.
• The US has 47.6 gastroenterologists per 1 million residents and 18.8 per 100,000 adults with MASLD, which equates to one gastroenterologist for every 5322 adults with MASLD.
• Under ideal conditions — including consecutive 40-hour weekly scanning — all 15.1 million US adults with MASLD and a Fibrosis-4 score ≥ 1.3 would undergo elastography assessments within 9 months.

IN PRACTICE

“This is the first study to systematically map the geographic distribution of elastography units across the United States, revealing a striking nationwide insufficiency in the infrastructure required for MASLD specialty care. Beyond this broad scarcity, vast swaths of the country lack meaningful access to either elastography or specialized gastroenterological services altogether, a phenomenon we term ‘Diagnostic Deserts,’ which encompass more than two thirds of US counties,” the authors of the study wrote.

SOURCE

The study was led by Mitchell W. Clayton, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota. It was published online in the American Journal of Gastroenterology.

LIMITATIONS

The published counts of transient elastography and magnetic resonance elastography units were based on public websites and likely underestimated the true number of units. Federal data only counted gastroenterologists with MD degrees and did not include providers with other degrees, advanced practice providers in gastroenterology, or physicians with additional hepatology training. The results did not account for ultrasound shear wave elastography.

DISCLOSURES

The study was supported by grants from the National Center for Advancing Translational Sciences and the National Institutes of Health. One author reported receiving institutional grants from the National Institutes of Health and several pharmaceutical companies as well as serving as an advisor or consultant to several pharmaceutical companies.

https://www.medscape.com/viewarticle/poor-access-masld-care-most-us-patients-2026a1000o8r