Epidemiologic Assessment of Pediatric Inflammatory Bowel Disease Presentation in NYC During COVID-19

  1. Janet E. Rosenbaum
  2. Kenny Castro Ochoa
  3. Faria Hasan
  4. Alexa Goldfarb
  5. Vivian Tang
  6. Gitit Tomer
  7. Thomas Wallach

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Abstract

Inflammatory bowel disease (IBD) pathogenesis is thought to be induced by a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. Severe acute respiratory syndrome coronavirus 2 (SARS-nCoV2) may have increased capacity to generate autoimmune disease as evidenced by known spikes in diseases such as type 1 diabetes mellitus. Public health interventions like masking and closures additionally created remarkable drops in typical viral infections, with remarkable shifts in influenza-like illness reporting in 2020. This study aims to evaluate the impact of SARS-nCoV2 and associated interventions on pediatric IBD presentation in New York City using records of new diagnoses at a consortium of 4 institutions between 2016 and June 2022. We fit time series model (autoregressive integrated moving average model) to monthly and quarterly number of cases of each disease for January 2016–March 2020 and forecast the period between April 2020 and June 2022. We note no decrease in ulcerative colitis (UC) or Crohn disease (CD) in the aftermath of historic low levels of overall viral illness, and statistically significant increases in CD diagnoses and elevation in UC diagnoses creating a trend suggesting overall increase in IBD diagnoses exceeding the baseline rate of increase. These data suggest a possible linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation.

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  1. Version published to 10.1097/mpg.0000000000003740
  2. ScreenIT

    SciScore for 10.1101/2022.03.23.22272167: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Data: After institutional review board approval of respective institutions, we extracted date of diagnosis for Crohn’s Disease (CD) (n=349) and Ulcerative Colitis (UC) (n=145) patients presenting in pediatric GI clinic diagnosed 2016-2021 from electronic health records (EHRs).
    Sex as a biological variableGender was a free entry field, and only male and female patients were present in the data; 44.0% were female and 56.0% were male.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    To show seasonal patterns in diagnoses, we plotted total cases by month with loess regression and 95% confidence intervals using ggplot2 stratified by pandemic versus pre-pandemic diagnosis.
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. IBD does not present with consistent patterns, resulting in wide variability in data. The 4-6 month lag between the city’s peak infection rate and CD is more consistent with a SARS-nCoV2 infection pathogenesis than with delayed presentation from cases during the lockdown period. Our data does not include all pediatric gastroenterology groups in NYC, which may create effects due to variations in patient choice of providers. Our study suggests a risk that large increases of SARS-nCoV2 infection in pediatric patients may drive increases in IBD diagnoses, in particular CD. Given recent widespread infection during the omicron wave, this study highlights the necessity of follow-up investigation of changes in incidence using existing data infrastructure.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.03.23.22272167v1 on medRxiv