Incidence of Isolated Biliary Atresia during the COVID Lockdown in Europe: Results from a Collaborative Project by RARE-Liver

on behalf of members of the Biliary Atresia and Related Disorders (BARD) Community & the ERN RA-RE-LIVER, Mark Nomden*, Naved K. Alizai, Pietro Betalli, Janneke L.M. Bruggink, Mara Cananzi, Vibeke Brix Christensen, Lorenzo D’Antiga, Mark Davenport, Björn Fischler, Luise Hindemith, Maria Hukkinen, Lars S. Johansen, Ruben H. de Kleine, Omid Madadi-Sanjani, Evelyn G.P. Ong, Mikko P. Pakarinen, Claus Petersen, Mathias Ruiz, Matthias SchunnEkkehard Sturm, Henkjan J. Verkade, Barbara E. Wildhaber, Jan B.F. Hulscher

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Article number775
Number of pages13
JournalJournal of Clinical Medicine
Volume12
Issue number3
DOIs
Publication statusPublished - Feb-2023

Keywords

  • biliary atresia
  • COVID lockdown
  • epidemiology
  • European reference network RARE-LIVER
  • stringency index

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