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Racial differences in reported Lyme disease incidence.

A D Fix1, C A Peña, G T Strickland

  • 1Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.

American Journal of Epidemiology
|October 29, 2000
PubMed
Summary

Racial disparities in Lyme disease incidence are significant statewide but lessen in endemic areas, suggesting exposure plays a role. Delayed diagnosis of early Lyme disease in African Americans may contribute to persistent differences.

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • Lyme disease incidence is disproportionately high in White populations in the US, often attributed to exposure risks.
  • Understanding racial differences in Lyme disease incidence and manifestations is crucial for targeted public health interventions.

Purpose of the Study:

  • To assess racial disparities in Lyme disease incidence and manifestations between White and African American populations in Maryland.
  • To evaluate the role of exposure risk in these racial differences, particularly in an endemic area.

Main Methods:

  • Analysis of reported Lyme disease cases in Maryland from 1992-1996.
  • Calculation of incidence rate ratios (IRRs) for Lyme disease and its manifestations (erythema migrans, arthritis) between racial groups.

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  • Comparison of statewide data with data from the Upper Eastern Shore, a focus of Lyme disease endemicity.

    • Main Results:

    • Statewide, White individuals had a significantly higher IRR for Lyme disease (6.3) and erythema migrans (17.7) compared to African Americans.
    • In the endemic Upper Eastern Shore area, the overall Lyme disease IRR decreased (1.8), and the IRR for erythema migrans was higher in African Americans (5.7), while arthritis IRR was similar (0.7).
    • White patients were more likely to present with erythema migrans, whereas African Americans were more likely to have arthritis, with a negative association between the two conditions.

    Conclusions:

    • While exposure risk accounts for much of the racial disparity in Lyme disease incidence, differences persist even in endemic areas.
    • Failure to recognize early Lyme disease (erythema migrans) in African Americans may lead to higher rates of late manifestations like arthritis.
    • Increased awareness of Lyme disease and its varied presentations among people of color and healthcare providers is essential, especially given the disease's geographic spread.