{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:18:36Z","timestamp":1783610316378,"version":"3.55.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Evidence on sex differences in the natural history of cirrhosis and cause-specific mortality remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare long-term all-cause and cause-specific mortality between male and female patients with cirrhosis.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based retrospective cohort study included hospitalized adults with cirrhosis identified from the California Department of Healthcare Access and Information database from January 2005 to December 2019. Propensity score matching (PSM) was used to balance baseline characteristics between male and female patients. Data were analyzed from August to December 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Sex (females compared with males).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Ten-year all-cause and cause-specific (liver-related [hepatocellular carcinoma (HCC) and non-HCC], non\u2013liver-related [cardiovascular and other]) mortality were assessed. Hazard ratios (HRs) of all-cause death were estimated using Cox models, and subdistribution hazard ratios (sHRs) of cause-specific death and receipt of liver transplantation (LT) were estimated using Fine-Gray competing risk models, stratified by age, race, ethnicity, social deprivation level, cirrhosis cause, and cirrhosis severity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 316\u202f957 patients with cirrhosis (124\u202f228 females [39.2%]; mean [SD] age, 61.4 [14.4] years; 192\u202f729 males [60.8%]; mean [SD] age, 58.8 [13.1] years), PSM yielded 110\u202f044 male-female pairs with balanced characteristics. Compared with males, females had lower estimated 10-year cumulative all-cause mortality (51\u202f703 patients [58.2%] vs 53\u202f310 patients [59.8%]), cardiovascular mortality (9215 patients [10.5%] vs 10\u202f531 patients [11.9%]), and HCC-related mortality (3255 patients [3.6%] vs 4745 patients [5.4%]), but higher non-HCC liver-related mortality (18\u202f572 patients [20.9%] vs 16\u202f993 patients [19.0%]). In Cox models, females had a lower hazard of all-cause death (HR, 0.94; 95% CI, 0.93-0.96). In Fine-Gray models, females had lower hazards of cardiovascular-related (sHR, 0.86; 95% CI, 0.84-0.89) and HCC-related (sHR, 0.68; 95% CI, 0.65-0.71) death, but a higher hazard of non-HCC liver-related death (sHR, 1.09; 95% CI, 1.07-1.12). Stratified analyses suggested that females younger than 50 years (sHR, 1.06; 95% CI, 1.02-1.11) and those with alcohol-associated cirrhosis (sHR, 1.12; 95% CI, 1.08-1.17) had higher hazard of liver-related mortality, and females were less likely to undergo LT (sHR, 0.77; 95% CI, 0.66-0.89).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of patients with cirrhosis, males had slightly higher all-cause mortality largely due to higher cardiovascular and HCC-related mortality, while females had higher non-HCC liver-related mortality; females younger than 50 years and those with alcohol-associated cirrhosis had higher liver-related mortality but lower rates of LT. These sex disparities warrant specific consideration in future guidelines for disease monitoring and transplant allocation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.22711","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:00:33Z","timestamp":1783609233000},"page":"e2622711","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in Long-Term Overall and Cause-Specific Mortality in Patients With Cirrhosis"],"prefix":"10.1001","volume":"9","author":[{"given":"Xiaonan","family":"Su","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 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California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taotao","family":"Yan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an, China"},{"name":"National Regional Infectious Diseases Center Co-constructed by National Health Commission, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Fan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramsey","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Division of 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