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Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC


Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
Emerging Infections Program

Emerging Infections Program

Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010

Christina A. NelsonComments to Author , Shubhayu Saha, Kiersten J. Kugeler, Mark J. Delorey, Manjunath B. Shankar, Alison Hinckley, and Paul Mead
Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (C.A. Nelson, K.J. Kugeler, M.J. Delorey, A.F. Hinckley, P.S. Mead)Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Saha, M.B. Shankar)


National surveillance provides important information about Lyme disease (LD) but is subject to underreporting and variations in practice. Information is limited about the national epidemiology of LD from other sources. Retrospective analysis of a nationwide health insurance claims database identified patients from 2005–2010 with clinician-diagnosed LD using International Classification of Diseases, Ninth Revision, Clinical Modification, codes and antimicrobial drug prescriptions. Of 103,647,966 person-years, 985 inpatient admissions and 44,445 outpatient LD diagnoses were identified. Epidemiologic patterns were similar to US surveillance data overall. Outpatient incidence was highest among boys 5–9 years of age and persons of both sexes 60–64 years of age. On the basis of extrapolation to the US population and application of correction factors for coding, we estimate that annual incidence is 106.6 cases/100,000 persons and that ≈329,000 (95% credible interval 296,000–376,000) LD cases occur annually. LD is a major US public health problem that causes substantial use of health care resources.
Lyme disease (LD) is a zoonotic infection transmitted by Ixodes spp. ticks and caused by the spirochete Borrelia burgdorferi. Signs and symptoms of infection range in severity and can include erythema migrans, arthritis, facial palsy, radiculoneuropathy, arrhythmia, and meningitis. Most patients recover fully after antimicrobial treatment (1,2); however, serious illness and even deaths have been reported, although rarely (35). In the United States, LD is the fifth most commonly reported nationally notifiable disease; ≈36,000 confirmed and probable cases were reported in 2013 (6). US cases are concentrated heavily in the Northeast and upper Midwest (7).
Surveillance for LD in the United States is based on reports submitted by laboratories and health care providers to state and local health departments. These reports provide valuable insight into the age and sex distribution of patients with LD and the seasonality and geographic distribution of cases, and they enable monitoring of disease trends over time. Unfortunately, underreporting and variation in surveillance practices limit the ability of routine surveillance to capture the true overall frequency of LD within the population (8). Studies conducted during the 1990s in high-incidence states suggest that LD cases are underreported by a factor of 3 to 12 (912). These studies were limited to specific states and do not necessarily reflect underreporting nationwide.
Medical claims data provide an additional source of information about the epidemiology and public health importance of LD. Because these data are based on billing records submitted by clinicians for reimbursement, they are less prone to underreporting than are routine surveillance data that require additional documentation. We used information from a large, nationwide medical claims database to 1) describe the epidemiology of LD diagnosed by clinicians, 2) identify similarities and differences with surveillance data, and 3) estimate the number of LD cases per year in the United States.

Dr. Nelson is a medical epidemiologist at the Bacterial Diseases Branch, Division of Vector-Borne Diseases, CDC, Fort Collins, Colorado. Her primary research interests are the epidemiology and clinical manifestations of LD, Bartonella infections, tularemia, and plague.


We are extremely grateful to Julie Ray, Elizabeth Schiffman, Heather Rutz, Katherine Feldman, Joshua Clayton, Jennifer White, Nadia Thomas, David McClure, Carla Rottscheit, Edward Belongia, & Allison Naleway for retrieving and sharing additional archived data related to their studies. We thank C. Ben Beard for his assistance with initiating this study and Brian Dixon for helpful feedback on the manuscript. Finally, we thank Truven Health Analytics, Peter Hicks, and CDC’s Division of Health Informatics and Surveillance for facilitating access to and analysis of the MarketScan database.


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Technical Appendix

Suggested citation for this article: Nelson CA, Saha S, Kugeler KJ, Delorey MJ, Shankar MB, Hinckley AP, et al. Incidence of clinician-diagnosed Lyme disease, United States, 2005–2010. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/eid2109.150417
DOI: 10.3201/eid2109.150417

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