Transgender Individuals Have Higher Rate of Alcohol and Viral Cirrhosis

Compared with cisgender adults, transgender individuals have a higher prevalence of cirrhosis, depression, and anxiety, according to study results published in the American Journal of Gastroenterology.

Previous research has found that transgender individuals were more likely to have alcohol use disorder and viral hepatitis, which may indicate that the transgender population has a higher rate of cirrhosis.

Investigators sourced data for this study from Optum’s de-identified Clinformatics® Data Mart Database (CDM), which includes medical claims data from more than 60 million patients in the United States. Adults (N=64,615,316) were evaluated for liver-related outcomes and all-cause mortality between 2007 and 2022 on the basis of trans- or cisgender status. To balance for cohort differences, an inverse probability treatment weighting (IPTW) approach was used.

Overall, 0.07% (n=42,417) were transgender adults.

The rates of anxiety (50.1% vs 19.4%) and depression (43.5% vs 15.0%) were higher among the transgender adults compared with cisgender adults, respectively.

A total of 329,251 individuals were diagnosed with cirrhosis during follow-up, among whom 0.09% were transgender. The prevalence of cirrhosis was higher among transgender adults (1,285 per 100,000 adults) than cisgender adults (561 per 100,000 adults).

The trans- (n=293) and cisgender (n=328,958) groups with cirrhosis comprised 50.2% and 54.5% men, 44.0% and 50.0% were aged 65 years and older, 60.1% and 62.6% were White, 57.0% and 53.7% had liver decompensation, 14.3% and 8.9% had hepatocellular carcinoma, and they had a median modified Charlson Comorbidity Index of 4.0 (IQR, 2.0-7.0) and 3.0 (IQR, 1.0-5.0), respectively.

The transgender individuals were more likely to have alcohol (57.5% vs 51.0%) or viral (30.5% vs 24.2%) cirrhosis etiologies, had a similar rate of metabolic-associated steatotic liver disease (12.3% vs 11.9%), and were less likely to have other etiology cirrhosis (21.1% vs 26.7%) compared with cisgender individuals, respectively.

The prevalence of anxiety (70.7% vs 43.2%), depression (66.4% vs 38.4%), drug-use disorder (52.3% vs 42.4%), HIV or AIDS (8.5% vs 1.6%), and use of dialysis (6.9% vs 4.1%) were higher among transgender individuals with cirrhosis than cisgender individuals, respectively.

The trans- and cisgender cirrhosis cohorts had similar age-standardized incidences of death (12.0 vs 14.0 per 100 person-years [py]), decompensation (15.7 vs 14.1 per 100 py), and liver transplantation (0.3 vs 0.3 per 100 py), respectively. The 5-year survival probability was 63.4% among transgender adults with cirrhosis and 59.1% among cisgender adults with cirrhosis.

Study limitations include the fact that the study may have missed some transgender adults, as the prevalence of transgenderism in the general population is estimated to be as high as 0.3%. However, only 0.07% of the study population was identified as transgender.

Study authors concluded, “[W]e find that trans- (vs cis-) gender adults have more than double the prevalence of cirrhosis and higher prevalence of co-morbidities associated with liver disease progression. However, we did not find a significant difference in liver-related outcomes and mortality in trans- vs cis-gender patients.”

This article originally appeared on Gastroenterology Advisor