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Reduced Presentation of Biliary Atresia During the COVID-19 Lockdown: A Population Based Observational Study
Adam Arshad1, Alastair Sutcliffe1, Vandana Jain2
1From University College London and Great Ormond Street Institute of Child Health, London, United Kingdom.
Insights
Biliary atresia (BA) cases significantly decreased during the initial COVID-19 lockdown in England and Wales. Referrals for BA were delayed following pandemic restrictions, impacting timely treatment.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Epidemiology
Background:
- Biliary atresia (BA) is a rare neonatal liver disease requiring prompt diagnosis and treatment.
- The COVID-19 pandemic and associated lockdowns may have altered healthcare-seeking behaviors and hospital presentations.
- Understanding changes in BA incidence during the pandemic is crucial for public health planning.
Purpose of the Study:
- To evaluate changes in the presentation of biliary atresia (BA) in England and Wales during the COVID-19 lockdowns.
- To compare BA case incidence during lockdown periods (2020-2021) with pre-pandemic years (2017-2019).
Main Methods:
- A population-based study analyzing confirmed BA cases in England and Wales from January 2020 to December 2021.
- Comparison of BA case numbers during January-June 2020 and 2021 with the same periods in 2017, 2018, and 2019.
- Statistical analysis using a two-sided t-test to determine significance.
Main Results:
- A significant reduction in presenting BA cases was observed during January-June 2020 (8 cases) compared to pre-pandemic averages (16, 13, 18 cases).
- While the reduction was not significant in 2021 (12 cases), the overall trend indicated fewer presentations during lockdowns.
- The mean time to the Kasai procedure did not differ during lockdowns, but was significantly higher after lockdown periods ended.
Conclusions:
- The first COVID-19 lockdown was associated with a significant decrease in biliary atresia presentations in England and Wales.
- Delayed referrals for BA were noted following the lifting of pandemic restrictions.
- These findings highlight potential impacts of public health crises on the diagnosis of critical pediatric conditions.
Objective:
The aim of this study was to assess whether there has been a change in presentations of biliary atresia (BA) in England and Wales during the first and second coronavirus disease 2019 (COVID-19) lockdowns (January-June 2020 and 2021).
Design:
This population study assessed all confirmed cases of BA, from January 2020 to December 2021 across the 3 UK pediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January to December 2017, 2018, and 2019.
Results:
During January-June 2020 and 2021, there were only 8 and 12 presenting cases of BA in England and Wales, compared to 16, 13, and 18 for the same time periods in 2017, 2018, and 2019, respectively. This difference was significant in a two-sided t test for 2020 ( P = 0.035) but not for 2021 ( P = 0.385). There was no difference in the mean days to Kasai procedure in January-June 2020 and 2021 compared to 2017-2019; however average time to Kasai after the lockdown periods was significantly higher.
Conclusions:
There was a significant reduction in the presenting cases of BA during the first COVID-19 lockdown, with an increased time for BA referrals after the pandemic lockdowns were lifted in England and Wales.
