Prevalence of cirrhosis ‘more than double’ in transgender vs. cisgender adults
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Key takeaways:
- Transgender adults had more than double the prevalence of cirrhosis vs. cisgender adults.
- They also had higher rates of anxiety, depression and HIV/AIDS and alcohol and viral etiologies for cirrhosis.
Transgender adults had “more than double” the prevalence of cirrhosis vs. cisgender adults, as well as higher rates of comorbidities linked to liver disease progression, researchers reported in The American Journal of Gastroenterology.
“Before this study, there were no liver-specific data focused on transgender individuals,” Brian P. Lee, MD, MAS, study author and associate professor of medicine in the division of gastrointestinal and liver diseases at Keck School of Medicine of USC, told Healio. “To move toward providing equitable care, we need to better understand the landscape of liver disease among transgender individuals, who we hypothesized might be at greater risk for liver disease.”
In a retrospective study, Lee and colleagues used Optum’s deidentified Clinformatics Data Mart Database to identify 64,615,316 commercially insured transgender and cisgender adults between 2007 and 2022, of whom 42,471 (0.07%) were transgender.
Researchers used billing codes to determine the prevalence of cirrhosis in the cohort, as well as the age-standardized prevalence among both transgender and cisgender groups. They also identified causes of cirrhosis and medical comorbidities and calculated incidence densities of liver-related outcomes and all-cause mortality.
According to study results, there were 329,251 individuals with cirrhosis in the entire cohort, of whom 293 (0.09%) were transgender. Compared with cisgender adults, transgender individuals had a higher age-standardized prevalence of cirrhosis (1,285 per 100,000; 95% CI, 1.136-1,449 vs. 561 per 100,000; 95% CI, 559-563), and those with cirrhosis also had higher age-standardized rates of anxiety (70.7%; 95% CI, 56.9-86.9 vs. 43.2%; 95% CI, 42.7-43.8), depression (66.4%; 95% CI, 53.3-81.7 vs. 38.4%; 95% CI, 37.9-38.9) and HIV/AIDS (8.5%; 95% CI, 3.9-16.1 vs. 1.6%; 95% CI, 1.5-1.7).
In addition, age-standardized proportions of alcohol (57.5%; 95% CI, 46-71.1 vs. 51%; 95% CI, 50.5-51.6) and viral (30.5%; 95% CI, 22.8-39.8 vs. 24.2%; 95% CI, 23.9-24.5) etiologies for cirrhosis were higher among transgender individuals. However, both groups had similar age-standardized incidence densities of death (transgender, 12; 95% CI, 8.8-15.3 vs. cisgender, 14; 95% CI, 13.9-14.2), liver decompensation (15.7; 95% CI, 10.9-20.5 vs. 14.1; 95% CI, 14-14.3) and liver transplantation (0.3; 95% CI, 0-0.8 vs. 0.3; 95% CI, 0.3-0.4) per 100 person-years.
“Transgender vs. cisgender individuals have more than double the prevalence of cirrhosis, especially due to alcohol and/or viral hepatitis,” Lee said. “Yet, once cirrhosis is diagnosed, the rates of poor outcomes like liver decompensation or death were the same among transgender vs. cisgender individuals.”
In addition, inverse probability treatment weighting survival analysis, which balanced demographic and clinical characteristics among the two groups, revealed similar 5-year survival probability (63.4%; 95% CI, 56.6-71.1 vs. 59.1%; 95% CI, 58.7-59.4).
“Cirrhosis represents end-stage liver disease that has usually occurred over years, and we need to be able to identify and treat risk factors for liver disease earlier to prevent cirrhosis,” Lee told Healio. “Thus, our results suggest that transgender individuals need to be screened and aggressively treated for risk factors of liver disease.”
He continued, “Furthermore, the high rates of anxiety and depression that we observed among transgender individuals, which are conditions known to prompt hazardous alcohol use to cope, suggest that more needs to be done to address stigma faced by transgender individuals and [to provide] greater access to mental health resources.”
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