Biliary atresia incidence in Taiwan before, during, and after the COVID‐19 pandemic: A nationwide population‐based study
Hsuan‐Fan Tung, Jyun‐Hong Jiang, Shin‐Yi Lee, Jiin‐Haur Chuang, Yi‐Wen TsaiAbstract
Objectives
To evaluate whether COVID‐19 nonpharmaceutical interventions (NPIs) were associated with changes in biliary atresia (BA) incidence and in late Kasai portoenterostomy in Taiwan.
Methods
We conducted a nationwide population‐based cohort study of all confirmed BA cases in Taiwan from January 2004 to December 2023. Monthly BA incidence was calculated per 10,000 live births. COVID‐19 policy phases were defined as No NPI (Jan 2004–Dec 2019), NPI (Jan 2020–Nov 2022), NPI‐relaxation (Dec 2022–Feb 2023), and Post‐NPI (Mar–Dec 2023). Phase‐specific incidence rate ratios (IRRs) were estimated using Poisson regression with live births as an offset and calendar‐month fixed effects. Late Kasai was defined as portoenterostomy performed at age > 60 days; phase differences were assessed using logistic regression.
Results
A total of 586 infants with BA were identified (overall incidence 1.55/10,000). Crude incidence was 1.52/10,000 in No NPI (485 cases), 1.64/10,000 in NPI (73), 0.90/10,000 in NPI‐relaxation (3) and 2.18/10,000 in Post‐NPI (25) Compared with No NPI, adjusted IRRs were 1.08 (95% confidence interval [CI] 0.84–1.38) for NPI, 0.58 (0.19–1.82) for NPI‐relaxation, and 1.46 (0.98–2.19) for Post‐NPI. The proportion of late Kasai decreased from 35.3% in No NPI to 16.0% (4/25) in Post‐NPI (odds ratio 0.38, 95% CI 0.14–1.08).
Conclusion
The incidence of BA in Taiwan did not decline during the COVID‐19 NPI period, suggesting limited impact of reduced infectious exposure on BA occurrence. A trend toward fewer late Kasai procedures in the post‐NPI phase may reflect improved early detection or care delivery.