TRANSGENDER adults have been found to suffer from cirrhosis twice as often than cisgender individuals, in a recent study from the University of Southern California, Los Angeles, USA. Cirrhosis, a chronic, progressive end-stage liver disease that prevents the liver from functioning normally, is known to result from alcohol use disorder and viral hepatitis, among other factors. These leading factors have previously been shown to occur more frequently in transgender individuals, however little research exists examining if these risk factors translate to higher incidence rates of cirrhosis amongst these patients.
Research into this trend, led by Hirsch Elhence, Keck School of Medicine, University of Southern California, Los Angeles, USA, involved identifying all transgender and cisgender adults in Optum’s deidentified Clinformatics Data Mart Database between 2007 and 2022. The team used validated billing codes and calculated age-standardized prevalence of cirrhosis among cisgender vs transgender adults. Among those with incident cirrhosis diagnoses, they calculated age-standardized incidence densities of liver-related outcomes (decompensation, transplantation, hepatocellular carcinoma) and all-cause mortality. They examined 5-year survival using inverse probability treatment weighting to balance transgender and cisgender populations on demographic and clinical characteristics.
Of the 64,615,316 individuals included in the research, 42,471 (0.07%) were transgender. Among 329,251 adults with cirrhosis, 293 (0.09%) were transgender. Trans- (vs cis-) gender patients had higher prevalence of cirrhosis (1,285 per 100,000, 95% confidence interval [CI] 1,136–1,449, vs 561 per 100,000). Among adults with cirrhosis, transgender patients had higher proportions of anxiety than cisgender patients (70.7% [56.9–86.9] vs 43.2% [42.7–43.8]), as well as higher rates of depression (66.4% [53.3–81.7] vs 38.4% [37.9–38.9]), HIV/AIDS (8.5% [3.9–16.1] vs 1.6% [1.5–1.7]). Transgender individuals also faced higher rates of alcohol (57.5% [46.0–71.1] vs 51.0% [50.5–51.6]) and viral (30.5% [22.8–39.8] vs 24.2% [23.9–24.5]) aetiologies compared to cisgendered patients, although aetiologies had overlapping CIs. Transgender patients had similar incidence densities of death (12.0 [95% CI 8.8–15.3] vs 14.0 [13.9–14.2] per 100 person-years), decompensation (15.7 [10.9–20.5] vs 14.1 [14.0–14.3]), and liver transplantation (0.3 [0.0–0.8] vs 0.3 [0.3–0.4]). In inverse probability treatment weighting survival analysis, transgender and cisgender individuals had similar 5-year survival probabilities (63.4% [56.6–71.1] vs 59.1% [58.7–59.4]).
Elhence and team concluded that cirrhosis is indeed more prevalent amongst transgender adults than cisgender adults. This information, they commented, will be vital going forward, as researchers and clinicians will be better able to understand and improve care for transgender individuals.
Victoria Antoniou, EMJ
Reference
Elhence H et al. Characteristics and outcomes among us commercially insured transgender adults with cirrhosis: a national cohort study. AM J Gastroenterol. 2024;DOI: 10.14309/ajg.0000000000002907.
