Epidemiology of biliary atresia in England and Wales (1999–2006)
- 1Paediatric Liver Centre, King’s College Hospital, London, UK
- 2Institute of Child Health, London, UK
- 3Birmingham Children’s Hospital, UK
- 4St James’ University Hospital, Leeds, UK
- Correspondence to Professor Mark Davenport, Paediatric Liver Centre, King’s College Hospital, Denmark Hill, London SE5 9RS, UK;
- Accepted 10 May 2009
- Published Online First 19 May 2009
Objective: To identify the epidemiological characteristics of infants with biliary atresia in England and Wales, since centralisation of its management in 1999.
Methods: The care of infants with biliary atresia (BA) in England and Wales is centralised to only three centres. All infants (treated from January 1999 to December 2006) were identified from a prospective national database; demographic details were ascertained from medical records and compared between two groups based on presumed aetiology (isolated biliary atresia (IBA) and developmental biliary atresia (DBA) (for example, syndromic infants, biliary atresia splenic malformation, cystic biliary atresia)).
Results: There were 302 (133 male (44%)) infants with BA that could be divided into IBA (n = 219, 73%) and DBA (n = 76, 25%). The overall incidence was 0.58/10 000 (1 in 17 049) live births with marked regional differences along a north-west/south-east axis varying from 0.38 (north-west England) to 0.78 (south-east England)/10 000 live births (OR 2.05 (95% CI 1.26–3.41); p = 0.002). The commonest month of birth was September with December being the least common, although there was no evidence for significant seasonal variation (p = 0.2). Infants with DBA were more likely to be female (p<0.001), of white background (p = 0.01), first-born (p = 0.04) and to be formula-fed (p = 0.07). Infants of south Asian origin came to surgery at an older age (59 (IQ 45–75) versus 52 (IQ 42–65) days; p = 0.03).
Conclusions: There is a remarkable variation of incidence of biliary atresia within England and Wales, some of which may have been caused by factors related to a different aetiological and racial background.
Funding The project was encouraged and supported financially by the Children’s Liver Disease Foundation (Birmingham, UK). The views and conclusions expressed are independent of the CLDF.
Competing interests None.
Ethics approval Ethical approval was obtained from the King’s College Hospital Ethics and Research Committee, on behalf of the other institutions.
Contributors: MD had the original idea for the study. Data collection and statistical analysis was by EL, MD and MCB. The manuscript was written by EL and MD, with all authors contributing to the final version. MD acts as guarantor.
Provenance and Peer review Not commissioned; externally peer reviewed.