Importance: Alcohol-associated hepatitis (AH) has high mortality, and rates are increasing among adolescents and young adults (AYAs).

Question: Is sex associated with long-term liver-related outcomes among adolescents and young adults after first presentation of alcohol-associated hepatitis?

Findings: In a cohort study of 3340 adolescents and young adults from Ontario, Canada, female sex was associated with a 50% higher risk of developing cirrhosis compared with male sex. The rate of liver-related mortality also was higher among females.

Meaning: The findings of this study suggest that sex-specific interventions for alcohol-associated hepatitis among adolescents and young adults are urgently needed.