Cancer, decompensation more likely in men with cirrhosis than women
Men with cirrhosis had more than double the risk of hepatocellular carcinoma, a 63% higher risk of liver transplant, and a 16% higher risk of decompensated cirrhosis than women with the disease, and the differences were greatest in those with alcohol-related disease, a study found.
Male patients with cirrhosis have a significantly higher risk of decompensated cirrhosis, hepatocellular carcinoma, and liver transplant compared with their female counterparts, with differences especially pronounced in those with nonviral cirrhosis, a cohort study found.
Researchers assessed 438,706 adults (mean age, 56.8 years; 50.8% male) with cirrhosis from a U.S. private health insurance claims database between January 2007 and December 2022. Incidence of adverse liver events, including decompensated cirrhosis, hepatocellular carcinoma, and liver transplant, was the primary outcome. Propensity-score matching based on age, liver disease etiologies, geographic region, insurance type, specialty type, alcohol use disorder, obesity, baseline status of decompensation, and Charlson Comorbidity Index score yielded 169,711 pairs of female and male patients with similar baseline characteristics. Findings were published by JAMA Network Open on July 28.
Analyses of the pairs showed that men had a higher incidence (per 1,000 person-years) of decompensated cirrhosis (65.77 [95% CI, 64.74 to 66.81] vs. 55.35 [95% CI, 54.46 to 56.25]; P<0.001), hepatocellular carcinoma (6.98 [95% CI, 6.71 to 7.27] vs. 3.35 [95% CI, 3.17 to 3.54]; P<0.001), and liver transplant (10.23 [95% CI, 9.89 to 10.58] vs. 6.27 [95% CI, 6.01 to 6.52]; P<0.001), corresponding to hazard ratios of 1.16 (95% CI, 1.14 to 1.19), 2.10 (95% CI, 1.96 to 2.25), and 1.63 (95% CI, 1.54 to 1.71), respectively.
When patients were stratified by liver disease etiology, alcohol-related liver disease was most strongly associated with men's higher risk for adverse outcomes, including decompensated cirrhosis (HR, 1.13; 95% CI, 1.08 to 1.19), hepatocellular carcinoma (HR, 2.40; 95% CI, 2.01 to 2.88), and liver transplant (HR, 1.36; 95% CI, 1.21 to 1.53), followed by metabolic dysfunction-associated steatotic liver disease and hepatitis C. In patients with hepatitis B, there was only a significant difference on the outcome of hepatocellular carcinoma (HR, 1.60 [95% CI, 1.08 to 2.36]; P=0.02).
Limitations include that researchers were unable to perform competing risk analyses due to the lack of mortality data and that the database only included privately insured individuals, potentially limiting generalizability.
“Sex disparities should be taken into consideration in future guidelines and programs for disease monitoring, prevention, and treatment of patients with cirrhosis,” the authors concluded.
An accompanying editorial hypothesized that delayed presentation with more severe diseases may contribute to the disparate outcomes and suggested that efforts to improve early detection and linkage to cirrhosis care should be prioritized in these patients.
“A firm recognition of the scope and degree of sex-based differences in cirrhosis outcomes is required to begin the important work to address and eliminate these disparities,” the editorialists concluded.