Sex and racial disparities in clinical outcomes and health resource use among patients with primary biliary cholangitis in the United States.

BACKGROUND: Racial and sex disparities have been described in liver conditions, including primary biliary cholangitis (PBC). This study sought to understand how race/ethnicity and sex-based differences impact access to diagnosis, clinical outcomes, health resource use (HRU), and treatment among patients with PBC in the United States (US). METHODS: Komodo Research Database claims data (2016-2023) for adults diagnosed with PBC were analyzed retrospectively. Patients were grouped by race/ethnicity (White, Black, Hispanic, Asian, and Other) and separately by sex (male or female). Clinical characteristics, treatment patterns, and HRU outcomes were assessed pre-index and post-index. The index date was defined as the first claim with a PBC diagnosis code. Statistical significance for comparisons was defined as p<0.05. RESULTS: In total, 9554 and 11,591 patients were included in the race/ethnicity and sex analyses. Black and Hispanic patients (versus [vs.] White) and male patients (vs. female) had higher comorbidity burden and PBC-related symptoms pre-index. Post-index, Black patients (vs. White) had significantly higher risks of liver transplant and hospitalization due to hepatic decompensation (adjusted hazard ratio [HR] of 2.09 and 1.37, respectively). Hispanic patients (vs. White) had a significantly higher risk of developing cirrhosis (adjusted HR of 1.19). Males had a higher risk than females for all adverse outcomes. Most HRU outcomes were significantly higher for Black patients vs. White, while treatment rates and response rates to ursodeoxycholic acid were significantly lower for Black patients vs. White and male patients vs. female. CONCLUSIONS: These results highlight significant differences in disease management and treatment initiation across race/ethnicity and sex groups in the US. Improved provider awareness of such differences in PBC is required to support individualized management and ensure equitable access to PBC treatment.