Study exposes racial disparities in Lyme disease diagnosis and treatment times

A recent JAMA Network Open study investigates whether the time of Lyme disease (LD) diagnosis and treatment varies between Black and White patients. 

Study: Time to Diagnosis and Treatment of Lyme Disease by Patient Race. Image Credit: 24K-Production / Shutterstock.com

Background

LD, the most common vector-borne disease diagnosed throughout the United States, is caused by the bacterium Borrelia burgdorferi. In addition to its high prevalence throughout the United States, particularly the upper Midwest, northeastern, and mid-Atlantic regions, ticks that carry Borrelia burgdorferi can also be found in various parts of Europe and Canada.

Many wild animals, including white-tailed deer, mice, chipmunks, squirrels, possums, and raccoons, can be infected with Borrelia burgdorferi from the bite of ticks that carry this bacterium. In addition to these wild animals, humans and several domesticated animals, including dogs, horses, and sometimes cattle, can also be infected with Lyme disease.

The early diagnosis of LD is typically based on prompt detection of the erythema migrans (EM) rash that has a ‘bull’s eye’ appearance and is often warm to the touch. Other symptoms of LD may include fatigue, fever, headache, joint pain, and swollen lymph nodes.

Suppose a person infected with LD is left untreated. In that case, there is a risk of prolonged morbidity that begins with early disseminated disease developing between three and ten weeks after the initial tick bite. Therefore, it is vital to identify the gaps that inhibit early disease diagnosis. 

About the study

The current cross-sectional study examined data obtained from patients with a suspected LD diagnosis who were left untreated. Data from patients who received clinical diagnosis and treatment for LD were also considered. 

All patients recruited in this study visited a specialty clinic in suburban Maryland either for clinical care or research participation. The self-reported demographic information of the patients was obtained, along with their medical records. This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Study findings

A total of 1,395 patients were recruited for this study, 50.4% of whom were men with a median age of 48. The current study assessed the prevalence of LD based on race.

After matching age and gender, Black patients were found to be at a higher risk of disseminated disease by 4.93 times as compared to White patients. This estimation was based on the EM rash-only group comprising 949 patients.

In comparison to females, men were at an increased risk of experiencing disseminated disease. As compared to infected White patients, Black patients were subjected to a significantly longer period of time to start relevant antibiotic treatment.

More specifically, it took an average of about seven days for White patients to receive treatment as compared to about 35 days for Black patients. Nevertheless, White patients were associated with greater inappropriate antibiotic prescriptions as compared to Black patients.

Study implications

The current cross-sectional study indicated that, as compared to White patients with LD, Black patients are more likely to be diagnosed with disseminated manifestations. Consistent with prior surveillance and insurance claims reports, the study findings indicate that Black patients experience a longer time to receive appropriate treatment. 

Importantly, EM images of Black patients were considerably underrepresented, which could be attributed to racial discrimination and unequal healthcare access. This observation reflects the overall lack of darker skin representation in dermatology research journals and textbooks, which significantly limits the proper treatment of Lyme disease, as well as various other skin conditions, in patients with black and brown skin.

The small number of Black patients represented in the study cohort may affect the generalizability of the findings. Nevertheless, the current study highlighted significant differences in LD diagnosis and treatment due to racial discrimination. To ensure equitable reductions in LD burden in society, there is a need to increase awareness among clinicians and patients about LD and its presentation in different racial groups.