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Published on: June 5, 2014
Incidence of Isolated Biliary Atresia during the COVID Lockdown in Europe: Results from a Collaborative Project by
Mark Nomden1,2, Naved K Alizai3, Pietro Betalli2,4
1Division of Paediatric Surgery, Department of Surgery, University of Groningen, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands.
Insights
Stricter COVID-19 lockdowns in Europe were associated with a decrease in biliary atresia (BA) incidence. This study examined the link between lockdown strictness and the number of isolated BA (IBA) cases. Further research is needed due to study limitations.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Epidemiology
Background:
- Biliary atresia (BA) is a rare cholangiopathy potentially triggered by viral infections.
- Coronavirus disease-19 (COVID-19) lockdown restrictions aimed to curb infection transmission.
- Varying lockdown strictness across European countries prompted this investigation.
Purpose of the Study:
- To investigate the association between COVID-19 lockdown strictness and the incidence of isolated biliary atresia (IBA) in Europe.
- To analyze the impact of varying lockdown stringency on IBA diagnosis rates across European centers.
Main Methods:
- Data from 412 isolated BA patients born between 2015 and June 2020 were collected from 13 European centers.
- Monthly incidence of IBA was calculated, and the Stringency Index (SI) was used to quantify lockdown strictness.
- Statistical analysis assessed the relationship between the percentage change in monthly IBA cases and the SI.
Main Results:
- The median monthly incidence of IBA did not significantly change during lockdown (6 pre-lockdown vs. 7 during lockdown, p=0.34).
- A significant inverse association was found between lockdown strictness (SI) and the percentage change in IBA incidence (B = -0.73, p=0.03).
- The median age at Kasai portoenterostomy remained consistent between the pre-lockdown and lockdown periods.
Conclusions:
- A stricter COVID-19 lockdown in Europe appeared to coincide with a greater reduction in the monthly incidence of isolated BA.
- These findings suggest a potential link between stringent public health measures and decreased BA diagnoses.
- Results require cautious interpretation due to the inherent assumptions and limitations of the study design.
Background:
Biliary atresia (BA) is a rare cholangiopathy where one of the proposed aetiological mechanisms is an infectious viral trigger. Coronavirus disease-19 (COVID) lockdown restrictions were implemented to reduce the transmission of infections. Strictness of lockdown varied across European countries. This study aimed to investigate if there was an association between strictness of lockdown and change in isolated BA (IBA) incidence in Europe.
Methods:
We approached European centres involved in the European Reference Network RARE-LIVER. We included IBA patients born between 2015 and June 2020. We calculated the number of IBA patients born per centre per month. The Stringency Index (SI) was used as lockdown strictness indicator. The association between percentage change of mean number of IBA patients born per month and the SI was assessed.
Results:
We included 412 IBA patients from thirteen different centres. The median number of patients per month did not change: 6 (1-15) pre-lockdown and 7 (6-9) during lockdown (p = 0.34). There was an inverse association between SI and percentage change in IBA (B = -0.73, p = 0.03). Median age at Kasai portoenterostomy (days) did not differ between time periods (51 (9-179) vs. 53 (19-126), p = 0.73).
Conclusion:
In this European study, a stricter COVID-lockdown was seemingly accompanied by a simultaneous larger decrease in the number of IBA patients born per month in the lockdown. Results should be interpreted with caution due to the assumptions and limitations of the analysis.
