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TOPLINE:

Men with cirrhosis had higher risks for adverse liver events than women, including more than twice the risk for hepatocellular carcinoma. This sex-based risk disparity was more pronounced in nonviral cirrhosis, especially alcohol-related liver disease.

METHODOLOGY:

• Although women typically experience less-severe early-stage chronic liver disease, sex-based differences in advanced stages remain unclear.
• This retrospective study explored the association between sex and the risk for adverse liver events in propensity score-matched pairs of women and men with cirrhosis, using a US insurance claims database with up to 10 years follow-up.
• Primary outcomes were the incidence of decompensated cirrhosis, hepatocellular carcinoma, and liver transplant, with events defined as those occurring 6 months after initial cirrhosis diagnosis.
• Subgroup analyses were performed by major liver disease etiologies: hepatitis B virus, hepatitis C virus, alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD), and others.

TAKEAWAY:

• Researchers included 169,711 women (mean age, 58.1 years) and an identical number of men (mean age, 57.7 years).
• Compared with women, men with cirrhosis had significantly higher risks for decompensated cirrhosis (hazard ratio [HR], 1.16; P < .001), hepatocellular carcinoma (HR, 2.10; P < .001), and liver transplant (HR, 1.63; P < .001).
• By liver etiology, the greatest disparities occurred in alcohol-related disease, where men had higher risks for decompensated cirrhosis (HR, 1.13; P < .001), hepatocellular carcinoma (HR, 2.40; P < .001), and liver transplant (HR, 1.36; P < .001); this was followed by MASLD and hepatitis C virus infection.
• In patients with hepatitis B, sex differences were significant only for hepatocellular carcinoma, with men at a higher risk (HR, 1.60; P = .02).

IN PRACTICE:

“If differences in disease severity at presentation emerge, efforts to improve early detection and linkage to cirrhosis care should be prioritized. These methods can include the implementation of informatics-based tools to surveil available clinical data (eg, automated fibrosis-4 calculation, steatosis identification on imaging) within the electronic health record to identify patients at risk for advanced chronic liver disease, link them to specialty care, and initiate guideline-recommended surveillance,” experts wrote in an accompanying editorial.

SOURCE:

This study was led by Yu Shi, MD, PhD, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California. It was published online in JAMA Network Open.

LIMITATIONS:

This study relied on standardized diagnostic codes to identify cirrhosis complications, which may have introduced misclassification. Results may not be generalizable to uninsured populations, who potentially have more severe disease. The lack of laboratory data prevented the calculation of Model for End-Stage Liver Disease with sodium levels and Child-Pugh scores for the assessment of disease severity.

DISCLOSURES:

The Stanford Center for Population Health Sciences Data Core, which provided data for this study, was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences Clinical and Translational Science Award, as well as internal funding from Stanford University. One author reported receiving grants and personal fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.