S2392 Racial and Ethnic Disparities in Cirrhosis-Related Complications: A Retrospective Cohort Study

Introduction: Cirrhosis, a progressive and often terminal liver disease, is a leading cause of morbidity and mortality worldwide. Previous research has documented disparities in liver-related health outcomes, yet comprehensive, multi-ethnic analyses spanning multiple decades remain limited. This study investigates racial and ethnic disparities in the incidence of key cirrhosis-related complications to inform equitable clinical care and health policy better. Methods: A retrospective analysis was performed using de-identified, aggregated data from the TriNetX research network, including patients diagnosed with cirrhosis from 2000 to 2024. Patients were stratified by race and ethnicity into 6 groups: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, and Other Race. The primary outcomes assessed were the incidences of spontaneous bacterial peritonitis (SBP), esophageal varices, ascites, hepatic encephalopathy, and hepatocellular carcinoma (HCC). A 1:1 propensity score matching approach accounted for confounders, including age, sex, comorbidities (e.g., diabetes, hypertension, chronic kidney disease, and alcohol-related liver disease), and socioeconomic variables. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with White patients as the reference group. Results: Racial and ethnic differences were observed across all measured complications. American Indians or Alaska Natives exhibited the highest incidences of SBP (8.62%) and esophageal varices (35.32%). Ascites was most prevalent among Native Hawaiians or Other Pacific Islanders (42.41%), while hepatic encephalopathy was most frequent among American Indians or Alaska Natives (16.96%). In contrast, Asians had the lowest rates of SBP (3.38%) and esophageal varices (18.03%) but demonstrated the highest incidence of HCC (27.10%), emphasizing a unique oncologic burden. Conclusion: This large-scale analysis highlights significant racial and ethnic disparities in the manifestation of cirrhosis-related complications. The findings underscore the necessity for culturally sensitive and demographically targeted interventions, including enhanced screening strategies and access to specialized care. Addressing these disparities is essential to achieving equitable health outcomes across diverse populations.