Lower socioeconomic status: a risk factor for disseminated Lyme disease

Moon et al. explored the risk factors for disseminated Lyme disease using an electronic database from the Geisinger integrated health care system located in Pennsylvania. They based their data on both diagnostic and narrative text data.

One out of three of their disseminated Lyme disease cases were classified as disseminated cases. “Lyme arthritis was the most common manifestation (55%), followed by neurological manifestations (34%), carditis (6%), and secondary erythema migrans (7%),” wrote Moon and colleagues. Another 6% were classified as other manifestations.

Individuals with lower socioeconomic status (SES) were more likely to develop disseminated Lyme disease.

An individual was classified as having a lower SES if they used Medical Assistance at least half the time. In contrast, individuals using urgent care or having a regular relationship with a primary care doctor were less likely to develop disseminated Lyme disease.

Significance of findings

This study reinforces the role of socioeconomic status as reported in an earlier Geisinger study of Lyme disease patients. “Delayed diagnosis and treatment was attributed to appraisal delays (e.g., due to symptom misattribution, intermittent symptoms, atypical or no erythema migrans), behavioral delays in seeking care (e.g., due to inadequate health insurance) and misdiagnosis in urgent care or emergency settings,” wrote the authors.

Although the study did not describe the risk of delayed diagnosis and treatment in urgent care centers, the authors raised such concerns. “We speculate that misdiagnosis in urgent or emergency settings would be more likely with atypical erythema migrans or in cases without any rash, which we could not reliably assess in this study.”

The study has several limitations, including staging the disease and review of records.

The authors conclude, “Intervening on these factors could reduce the individual and health care burden of disseminated Lyme disease.”