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Claims-Based Diagnostic Patterns of Patients Evaluated for Lyme Disease and Given Extended Antibiotic Therapy
Yi-Ju Tseng1,2,3, Alfred DeMaria4, Donald A Goldmann5,6
11 Computational Health Informatics Program, Boston Children's Hospital , Boston, Massachusetts.
Background:
A Lyme disease (LD) diagnosis can be far from straightforward, particularly if erythema migrans does not develop or is not noticed. Extended courses of antibiotics for LD are not recommended, but their use is increasing. We sought to elucidate the patient patterns toward a diagnosis of LD, hypothesizing that a subset of patients ultimately receiving extended courses antibiotics may be symptomatic for an extended period before the first LD diagnosis.
Methods:
Claims submitted to a nationwide U.S. health insurance plan in 14 high-prevalence states were grouped into standardized diagnostic categories. The patterns of diagnostic categories over time were compared between patients evaluated for LD and given standard antibiotic therapy (PLDSA) and patients evaluated for LD and given extended antibiotic therapy (PLDEA) in 2011-2012.
Results:
The incidence of PLDSA was 40.45 (N = 3207) and that of PLDEA was 7.57 (N = 600) per 100,000 insured over 2011-2012. 50.3% of PLDEA were diagnosed in the nonsummer months. Seven diagnostic categories were associated with PLDEA. From 180 days before the first LD diagnosis, the risks of having claims associated with back problems (odds ratio [OR], 2.1; confidence interval [95% CI], 1.4-2.9; p < 0.001) and connective tissue disease (OR, 1.6; 95% CI, 1.1-2.3; p < 0.01) complaints were higher among PLDEA. From 90 days before the diagnosis, malaise and fatigue (OR, 1.7; 95% CI, 1.1-2.6; p < 0.05), other nervous system disorders (OR, 2.0; 95% CI, 1.3-3.1; p < 0.01), and nontraumatic joint disorder (OR, 1.4; 95% CI, 1.0-2.0; p < 0.05) were more likely found among PLDEA than PLDSA. From 30 days before the diagnosis, the risk for mental health (OR 1.6; 95% CI, 1.1-2.0; p < 0.01) and headache (OR 1.5; 95% CI, 1.1-2.0; p < 0.05) among PLDEA was elevated.
Conclusions:
Among patients evaluated for LD and ultimately receiving an extended course of antibiotics for LD, 15.8% of them were symptomatic and seeking care for several months before their first LD diagnosis.
Insights
Many patients receiving extended Lyme disease (LD) antibiotic courses experience symptoms for months prior to diagnosis. This study analyzed diagnostic patterns, revealing increased risks for specific conditions preceding LD diagnosis in this group.
Area of Science:
- Infectious Diseases
- Public Health
- Medical Informatics
Background:
- Lyme disease (LD) diagnosis can be challenging, especially without classic erythema migrans.
- The use of extended antibiotic courses for LD is increasing, despite not being recommended.
- Patient diagnostic trajectories leading to LD diagnosis require further elucidation.
Purpose of the Study:
- To investigate patient patterns leading to a Lyme disease diagnosis.
- To identify if patients receiving extended antibiotic therapy for LD experienced prolonged symptomatic periods before initial diagnosis.
Main Methods:
- Analysis of claims data from a U.S. health insurance plan across 14 high-prevalence states (2011-2012).
- Comparison of diagnostic category patterns over time between patients receiving standard (PLDSA) and extended (PLDEA) antibiotic therapy for LD.
- Statistical analysis of diagnostic claims from 180, 90, and 30 days prior to the first LD diagnosis.
Main Results:
- Incidence rates: PLDSA 40.45/100,000; PLDEA 7.57/100,000.
- 50.3% of PLDEA were diagnosed outside of summer months.
- Pre-diagnosis claims revealed elevated risks for back problems, connective tissue disease, malaise/fatigue, nervous system disorders, joint disorders, mental health issues, and headaches in the PLDEA group.
Conclusions:
- A significant proportion of patients receiving extended LD antibiotic courses (15.8%) were symptomatic for months before their initial LD diagnosis.
- These findings suggest potential delays or complexities in diagnosing Lyme disease, contributing to prolonged treatment courses.
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