Characteristics and Outcomes Among US Commercially Insured Transgender Adults With Cirrhosis: A National Cohort Study

Abstract

INTRODUCTION: The National Institute on Minority Health and Health Disparities has noted that transgender individuals experience unique health disparities. We sought to describe the landscape of transgender patients with cirrhosis. METHODS: We identified all transgender and cisgender adults in Optum's deidentified Clinformatics Data Mart Database between 2007 and 2022 using validated billing codes and calculating age-standardized prevalence of cirrhosis among cisgender vs transgender adults. Among those with incident cirrhosis diagnoses, we calculated age-standardized incidence densities of liver-related outcomes (decompensation, transplantation, hepatocellular carcinoma) and all-cause mortality. We examined 5-year survival using inverse probability treatment weighting to balance transgender and cisgender populations on demographic and clinical characteristics. RESULTS: Among 64,615,316 adults, 42,471 (0.07%) were transgender. Among 329,251 adults with cirrhosis, 293 (0.09%) were transgender. Trans- (vs cis-) genders had higher prevalence of cirrhosis (1,285 [95% confidence interval (CI) 1,136–1,449] per 100,000 vs 561 [559–563] per 100,000). Among adults with cirrhosis, trans- (vs cis-) genders had higher proportions of anxiety (70.7% [56.9–86.9] vs 43.2% [42.7–43.8]), 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]), and 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]) etiologies, although etiologies had overlapping CIs. Trans- (vs cis-) genders 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]). DISCUSSION: Trans- (vs cis-) gender adults have double the prevalence of cirrhosis, and the majority have a diagnosis of anxiety and/or depression. These results are informative for researchers, policymakers, and clinicians to advance equitable care for transgender individuals.