ABSTRACT
Background: One of the myriad issues COVID-19 has generated is a concern for increased capacity to generate autoimmune disease. (Saad et al, 2020, Ehrenfeld et al 2020). Recent case reports have potentially linked new onset UC associated with recent COVID infection (Aydin et al 2020), which raises concern for potential impact of COVID-19 infection rates on pediatric IBD diagnosis rates. As non-pharmaceutical interventions massively decreased the incidence of infectious illnesses in the first year of the pandemic (Sullivan et al, 2020), IBD rates would likely be expected to stay stable or decrease. We have formed a consortium of New York City pediatric institutions aimed at characterizing this change, and here report findings from the Children's Hospital of Montefiore, Maimonides Medical Center, SUNY Downstate, and New York University. Methods: New IBD diagnoses were identified between 2016-2019, as well as new diagnoses documented between 3/2020 and 3/2021. Data was examined using a direct comparison of new diagnostic rate 3/20-3/21 to mean diagnostic rate from 2013-2019. Results: an overall secular increase in IBD diagnostic rate of approximately 5% was noted, consistent with prior findings demonstrating increased incidence of IBD annually (Ye et al, 2020). Direct comparison with mean diagnostic rate over the preceding 4 years noted a substantial increase in diagnostic rate in the pandemic year relative to previous year average, with 109 new diagnoses in our consortium compared to an average of 79. Our data demonstrates this increase is driven by the institutions in the Brooklyn and the Bronx, with a 51% increase in diagnoses (78 compared to mean of 51.5, 95% CI 10.19). NYU diagnostic rate was 31 (previous mean of 27.5, 95% CI 5.29). This aligns well with published rates of COVID-19 in these regions, with the outer boroughs averaging 14,169 cases/100k and Manhattan 10,516/100k. Discussion: Our results suggest a possible increase in IBD diagnostic rate in the outer boroughs of New York City, aligning with density of COVID-19 infections, despite surveillance data from NYC DOH demonstrating almost nonexistent pediatric influenza-like-illness. There are many possible confounding factors in this initial work with substantial further evaluation needed, but this data is suggestive of a possible capacity for COVID19 to generate new onset IBD in excess of normal infections and normal rates of presentation. Next steps will include expanding data collection to additional NYC institutions, subgroup analysis by disease type, gender, age of presentation, more detailed analysis of biomarkers, and geospatial analysis given geographic variations in COVID19 infection density.