678 - Changing Epidemiology of Biliary Atresia in Infants Before and After the COVID-19 Pandemic: A Multi-Institutional TriNetX Analysis

Publication Number: 4663.678

Tina Maria Moreck, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Dana Goldner, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Olumide Arigbede, State University of New York Downstate Medical Center College of Medicine, New York City, NY, United States; Thomas Wallach, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States

Background: Biliary atresia (BA) is a progressive fibro-obliterative cholangiopathy of infancy and the leading indication for pediatric liver transplantation. Although its etiology remains unclear, infectious and immune-mediated triggers have been proposed. Recent reports suggest changes in neonatal disease patterns following the COVID-19 pandemic, yet data on BA incidence trends remain limited

Objective: To evaluate changes in the incidence and incidence rates of biliary atresia among infants aged 0-3 years before and after the COVID-19 pandemic using a large, multicenter database.

Design/Methods: A retrospective cohort study was conducted using the TriNetX Research Network, encompassing 111 healthcare organizations. Infants aged 0-3 years diagnosed with BA (ICD-10-CM: Q44.2) between March 2017 and February 2024 were included. Incidence rates (cases per person-day) were calculated for the pre-pandemic period (March 2017-February 2020) and the post-pandemic period (March 2020-February 2024). Poisson regression with standard errors and chi-square tests were done for rate and proportion comparisons, respectively. Results were stratified by sex, race, and ethnicity. Bonferroni correction was applied for multiple comparisons (adjusted α=0.0083). Statistical analyses were conducted using the TriNetX platform and R Statistical Software version 4.5.1.

Results: Among 3,810 infants with BA, overall incidence increased significantly from 11.17 (95% CI: 10.79-11.57) to 14.12 (95% CI: 13.52-14.75) cases per 1,000 person-days, representing a 26.4% increase ( [RR]=1.26; 95% CI: 1.21-1.32; P< 0.001). Both sexes demonstrated significant increases (female: RR=1.23, 95% CI: 1.16-1.31; male: RR=1.33, 95% CI: 1.25-1.41; P< 0.001). Profound racial differences emerged: Black/African American (RR=1.62; 95% CI: 1.48-1.77), Hispanic/Latino (RR=1.61; 95% CI: 1.48-1.76), and Asian (RR=1.56; 95% CI: 1.39-1.75) infants experienced 4-5 times greater relative increases than White infants (RR=1.13; 95% CI: 1.08-1.19), with significant race×time interaction (χ²=47.3, P< 0.001). All comparisons remained significant after Bonferroni correction.

Conclusion(s): In this large multicenter cohort, BA incidence increased significantly after the onset of the pandemic, with a 26% rise and disproportionate elevations among Black, Hispanic, and Asian infants. These findings suggest potential pandemic-related influences on early hepatobiliary and immune development and highlight racial disparities. Further studies integrating maternal-infant viral exposure, microbiome data, and social determinants are needed to clarify mechanisms and guide preventive strategies.

Biliary Atresia Incidence by Race, 2017-2024


Biliary Atresia Incidence by Sex, 2017-2024


Temporal Trends in Biliary Atresia Incidence, 2017-2024