In one nonexpansion state, 2 large centers with a combined 2800 listings each had 0.2% Medicaid-insured patients, while a smaller center had 26.6%. Waitlist mortality was lower among privately insured patients in both expansion and nonexpansion states.
“This gap is even more pronounced in the highest-volume [liver transplant] centers, further exacerbating disparities,” the authors wrote.
Liver Disease Disparities in Resmetirom and Hepatitis C Treatment
A retrospective comparison of 747 patients with metabolic dysfunction–associated steatotic liver disease who received resmetirom (Rezdiffra; Madrigal Pharmaceuticals) and 169,839 who did not found that Black patients accounted for 5% of resmetirom users vs 9% of comparators (P = .0008).3 The authors cautioned that this “should be interpreted as a modest access signal, not proof of independent prescribing inequity,” given higher rates of unknown race documentation and limited socioeconomic data.
In a systematic review and meta-analysis of 12 US observational studies including 660,513 patients with chronic hepatitis C, Black patients (pooled OR, 0.88; 95% CI, 0.80-0.98) and Hispanic patients (pooled OR, 0.74; 95% CI, 0.57-0.96) had lower odds than White patients of starting direct-acting antiviral therapy.4 Heterogeneity across studies was substantial, though the direction of effect was largely consistent.
Three of the studies were retrospective, and the resmetirom comparison was unadjusted and did not account for fibrosis stage, payer status, or treatment eligibility. The meta-analysis pooled observational studies with high heterogeneity, and the surveillance study, while prospective, included only patients already connected to care. None of the studies has yet been published in a peer-reviewed journal.
The resmetirom investigators called for adjusted studies to evaluate payer status, specialty access, geography, and eligibility “to ensure that MASH-directed therapy does not widen existing liver-disease disparities.”3
References
1. Al-Hasan M, Rich N, Quirk L, et al. Social determinants of health and HCC surveillance receipt in patients with cirrhosis: a multicenter cohort study. Paper presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, Colorado. Abstract 0121.
2. Rosenblatt R, Goldberg D. Having insurance is not enough: Medicaid insured patients still lack equitable access to listing for liver transplant. Paper presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, Colorado. Abstract 0127.
3. Ezeano C, Kanu I, Boateng S, et al. New therapy, old equity questions: racial disparities in resmetirom use for MASLD. Poster presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, Colorado. Abstract 3564.
4. Syed A, Zahid MD, Akinditan V, Hasan S, Bari K. Unequal access to curative therapy: racial and ethnic disparities in direct-acting antiviral treatment for chronic hepatitis C in the United States. Paper presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, Colorado. Abstract 0120.
