Disparities in liver-related care among transgender adults with steatotic liver disease: a retrospective cohort study.

IF 4.4 Q2 ENDOCRINOLOGY & METABOLISM

Journal of the Endocrine Society Pub Date : 2026-06-16 eCollection Date: 2026-07-01 DOI:10.1210/jendso/bvag129

Maria Ortega Abad, Leandro Sierra, Nikki Duong, Ricardo Correa

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Abstract

Background: Transgender (TGD) adults experience healthcare disparities across multiple domains, yet care for steatotic liver disease (SLD) remains uninvestigated.

Aims: Evaluate whether TGD adults with SLD receive equitable liver-related care compared with cisgender (CGD) adults.

Methods: Retrospective cohort study conducted at a tertiary medical center (2015-2025). Adults with SLD were identified by a 2-step process (ICD-10 codes, manual chart review). Patients with other causes of liver disease and missing data were excluded. TGD status was defined by ICD-10 codes for gender dysphoria, documented gender incongruence or use of gender affirming hormone therapy. Controls and cases were selected from the same cohort with a 2:1 sampling ratio. Primary outcomes, gastroenterology consultation, hepatology assessment (FIB-4, elastography, or biopsy), and advanced workup, were analyzed using logistic regression adjusting for age and cardiometabolic covariates. An age restricted (30-60) sensitivity analysis was performed. Secondary outcomes included viral hepatitis screening/vaccination, SLD-directed therapies, and 5-year BMI trajectories.

Results: Among 254 adults (85 TGD, 169 CGD), TGD individuals were younger (36.0 vs 57.0 years, P < .001) with higher MASLD prevalence (91.8% vs 77.5%, P = .05). TGD status was associated with lower odds of gastroenterology consultation (aOR 0.41; 95% CI .18-.93), any hepatology assessment (aOR 0.35; 95% CI .18-.70), advanced hepatology workup (aOR 0.34; 95% CI .17-.69), with robust findings in sensitivity analysis. GLP-1 agonist prescriptions were lower (9.4% vs 19.5%, P = .03), and BMI increased vs controls (P < .001).

Conclusion: TGD adults with SLD experience substantial disparities in care, requiring integrated, inclusive pathways to advance health equity.

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变性成人脂肪肝患者肝脏相关护理的差异：一项回顾性队列研究

背景：跨性别（TGD）成年人在多个领域经历医疗保健差异，但脂肪变性肝病（SLD）的护理仍未得到调查。目的：评估TGD合并SLD的成人与顺性别（CGD）成人相比是否得到了公平的肝脏相关护理。方法：2015-2025年在某三级医疗中心进行回顾性队列研究。成人SLD通过两步程序（ICD-10代码，手工图表审查）进行鉴定。排除了其他原因肝病和缺失数据的患者。TGD状态由ICD-10代码定义，用于性别不安、记录的性别不一致或使用性别肯定激素治疗。对照和病例均从同一队列中选取，抽样比例为2:1。主要结果、胃肠病学咨询、肝病评估（FIB-4、弹性成像或活检）和晚期随访，采用调整年龄和心脏代谢协变量的logistic回归进行分析。进行年龄限制（30-60岁）敏感性分析。次要结局包括病毒性肝炎筛查/疫苗接种、sld定向治疗和5年BMI轨迹。结果：254例成人（TGD 85例，CGD 169例）中，TGD患者年龄较轻（36.0岁vs 57.0岁，P < 0.001）， MASLD患病率较高（91.8% vs 77.5%, P = 0.05）。TGD状态与胃肠病学咨询（aOR = 0.41; 95% CI = 0.18 - 0.93）、任何肝病评估（aOR = 0.35; 95% CI = 0.18 - 0.70）、晚期肝病检查（aOR = 0.34; 95% CI = 0.17 - 0.69）的低几率相关，在敏感性分析中有可靠的发现。GLP-1激动剂处方减少（9.4% vs 19.5%, P = .03）， BMI较对照组增加（P < .001）。结论：患有特殊障碍的TGD成人在护理方面存在巨大差异，需要综合、包容的途径来促进卫生公平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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