Lyme disease more likely to affect older, wealthy white women

Author: Adrian O'Dowd
Lyme disease more likely to affect older, wealthy white women

Patients with Lyme disease in hospitals in England and Wales seem to be predominantly white, female and living in more affluent areas, according to a study* published in the open access journal BMC Public Health.

The study, which examined data on 2,361 hospital patients collected between 1998 and 2015, also found an increase in Lyme disease incidence over time, with the number of new cases peaking in August each year and higher rates in central southern and western England.

Lyme disease is a bacterial infection carried by ticks, with around 3,000 cases each year in the UK.

The researchers used anonymised health records to identify 2,259 patients in England and 102 patients in Wales who had been diagnosed with Lyme disease. Nearly two-thirds (60.1% or 1,005) were women or girls with peaks of new cases at the ages between six and 10, and 61 and 65 years.

Out of the 1,877 patients for whom ethnicity information was recorded 1,803 (96%) self-identified as white.

Dr John Tulloch of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool who is the corresponding author said: “In the UK, information relating to infected Lyme disease patients' characteristics, where they live and how they are managed within the NHS is not fully understood.

“Through our analysis of NHS hospital data we were able to identify demographic information about Lyme disease patients accessing hospitals for management and treatment and, for the first time, start to describe how they progress through the healthcare system.

“These data display a predominance of female cases of certain age groups, most of whom identify as white. The reasons for this are hard to explain, but could be related to differences in health seeking behaviour between women and men and an increased exposure to tick habitats due to leisure activities in children and older people, as opposed to occupational exposure in younger adults.

“The apparent association between ethnicity and Lyme disease is most likely due to sociocultural and behavioural reasons, for example living in areas that are more likely to see a higher abundance of disease-transmitting ticks.”

The data also showed that the number of new cases rose from 0.08 per 100,000 people in 1998 to 0.53 cases per 100,000 people in 2015.

The exact cause for the increase in Lyme disease incidence was unclear, said the authors, but could be the result of various factors, such as increased awareness by the public and/or hospital clinicians, increase in referrals by GPs, or a true increase in incidence within England and Wales.

Dr Tulloch said: “Almost all parts of England and Wales reported Lyme disease cases attending hospitals with clear hotspots of disease in central southern England.”

The authors also found that 30% of Lyme disease hospital admissions in England and 67.6% in Wales originated from the A&E department.

Dr Tulloch added: “Further work is needed to explore why so many patients would seek treatment at a hospital when, for the majority of cases, management could occur at primary care level.

“Being aware of the signs and symptoms of Lyme disease is important so that patients can receive early diagnosis and treatment from their family doctor.”

*Tulloch, et al. Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015). BMC Public Health 2019. DOI:10.1186/s12889-019-7245-8