title: Reduction of the ages at diagnosis and operation of biliary atresia in Taiwan: A 15-year population-based cohort study.
abstract: OBJECTIVE
  To describe the ages at diagnosis and operation of biliary atresia (BA) and its incidence over a 15-year period in Taiwan.
  
  
  METHODS
  This was a population-based cohort study. BA cases were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision (ICD-9) code of BA 751.61 plus Kasai operation (ICD-9 procedure code 51.37) or liver transplantation (LT, ICD-9 procedure code 50.5). The patients' characteristics including sex, age at diagnosis, age at receiving Kasai operation and age at receiving LT were compared among three birth cohorts: (1) 1997 to 2001; (2) 2002 to 2006; and (3) 2007 to 2011.
  
  
  RESULTS
  There were a total of 540 BA cases (275 females) with an incidence of 1.62 per 10000 live births. No seasonality of BA was noted. The mean ages at diagnosis of three cohorts were 57.9, 55.6 and 52.6 d. A linear regression model demonstrated a decreasing trend of the mean age at diagnosis (1.27 d per year). The proportion of BA cases that received the Kasai operation within 60 d of age increased from 76% to 81%. A total of 189 (35%) BA patients underwent LT. The mean age at LT was reduced from 3-year-old to 1-year-old. The rates of LT were 25.6% and 32.3% in patients who received the Kasai operation within 60 d or after 60 d of age, respectively. All patients who did not undergo a Kasai operation eventually required LT.
  
  
  CONCLUSIONS
  The ages at diagnosis and operation in BA cases have decreased over time. Kasai operation performed at younger age reduces the need for LT. The incidence of BA in Taiwan fluctuates, but without certain trend.
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Jen-Shyang
authors.initials: JS
authors.lastname: Lin
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Lu
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Yeung
authors.affiliation: Jen-Shyang Lin, Solomon Chih-Cheng Chen, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi 60002, Taiwan.
authors.forename: Wai-Tao
authors.initials: WT
authors.lastname: Chan
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016014:Linear Models; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000639:trends*; D012621:Seasons; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Age; Biliary atresia; Kasai operation; Liver transplantation; Stool color card