Enhancing Lyme Disease Surveillance by Using Administrative Claims Data, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

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Enhancing Lyme Disease Surveillance by Using Administrative Claims Data, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program

Emerging Infections Program

Enhancing Lyme Disease Surveillance by Using Administrative Claims Data, Tennessee, USA

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• The Study
• Conclusions
• Suggested Citation

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Joshua L. Clayton , Stephen G. Jones, John R. Dunn, William Schaffner, and Timothy F. Jones

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.L. Clayton); Tennessee Department of Health, Nashville, Tennessee, USA (J.L. Clayton, J.R. Dunn, T.F. Jones); Blue Cross Blue Shield of Tennessee, Chattanooga, Tennessee, USA (S.G. Jones); Vanderbilt University School of Medicine, Nashville (W. Schaffner)

Suggested citation for this article

Abstract

Lyme disease is underreported in the United States. We used insurance administrative claims data to determine the value of such data in enhancing case ascertainment in Tennessee during January 2011–June 2013. Although we identified ≈20% more cases of Lyme disease (5/year), the method was resource intensive and not sustainable in this low-incidence state.

Lyme disease is the most common tickborne disease in the United States, with >36,000 cases reported to the Centers for Disease Control and Prevention (CDC) during 2013 (1). Tennessee, a low-incidence state, reported only 25 Lyme disease cases during 2013 (2). In addition, Borrelia burgdorferi–infected ticks have been identified in only 1 Tennessee county (G.J. Hickling, unpub. data).

CDC estimates that Lyme disease may be underreported by a factor of 10 (3). A study using administrative claims data from a Tennessee health insurance provider similarly estimated that Lyme disease incidence is 7-fold higher than is reported to the Tennessee Department of Health (TDH) (4). To determine the usefulness of claims data, which can vary in accuracy (5,6), we evaluated medical records of persons given a Lyme disease diagnosis in claims data or surveillance in Tennessee.

This study was a special collaboration between TDH and BCBST medical informatics staff and required substantial resources of personnel and time, a level of surveillance not sustainable long-term. Although claims data offer an opportunity for identifying additional Lyme disease cases for public health surveillance, a more efficient means for differentiating cases from noncases is needed before such a system will be practical.

Dr. Clayton is an Epidemic Intelligence Service officer at CDC, assigned to the Tennessee Department of Health. His primary research interests include vector-borne diseases.

References

1. Centers for Disease Control and Prevention. Reported cases of Lyme disease by state or locality, 2004–2013. Atlanta: US Department of Health and Human Services; 2014 [cited 2014 Oct 10]. http://www.cdc.gov/lyme/stats/chartstables/reportedcases_statelocality.html.
2. Centers for Disease Control and Prevention. National notifiable diseases surveillance system (NNDSS): Lyme disease 2011 case definition. Atlanta: US Department of Health and Human Services; 2014 [cited 2014 Oct 10]. http://wwwn.cdc.gov/NNDSS/script/casedef.aspx?CondYrID=752&DatePub=2011-01-01.
3. Hinckley AF, Connally NP, Meek JI, Johnson BJ, Kemperman MM, Feldman KA, Lyme disease testing by large commercial laboratories in the United States. Clin Infect Dis. 2014;59:676–81 . DOIPubMed
4. Jones SG, Coulter S, Conner W. Using administrative medical claims data to supplement state disease registry systems for reporting zoonotic infections. J Am Med Inform Assoc. 2013;20:193–8. DOIPubMed
5. Sickbert-Bennett EE, Weber DJ, Poole C, MacDonald PDM, Maillard JM. Utility of International Classification of Diseases, Ninth Revision, Clinical Modification codes for communicable disease surveillance. Am J Epidemiol. 2010;172:1299–305. DOIPubMed
6. Campos-Outcalt DE. Accuracy of ICD-9-CM codes in identifying reportable communicable diseases. Qual Assur Util Rev. 1990;5:86–9.PubMed
7. Holzbauer SM, Kemperman MM, Lynfield R. Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected Lyme disease. Clin Infect Dis. 2010;51:369–70. DOIPubMed
8. Nadelman RB, Hanincova K, Mukherjee P, Liveris D, Nowakowski J, McKenna D. Differentiation of reinfection from relapse in recurrent Lyme disease. N Engl J Med. 2012;367:1883–90. DOIPubMed
9. Stegall-Faulk T, Clark DC, Wright SM. Detection of Borrelia lonestari in Amblyomma americanum (Acari: Ixodidae) from Tennessee. J Med Entomol.2003;40:100–2. DOIPubMed

Figure

• Figure. Identification of Lyme disease cases from the Tennessee Department of Health case-based surveillance and Blue Cross Blue Shield of Tennessee administrative claims data, Tennessee, USA, 2011–2013. BCBST, Blue Cross Blue...

Suggested citation for this article: Clayton JL, Jones SG, Dunn JR, Schaffner W, Jones TF. Enhancing Lyme disease surveillance by using administrative claims data, Tennessee, USA. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150344

DOI: 10.3201/eid2109.150344