JAMA Netw Open

Study uncovers racial disparities in Lyme disease diagnosis, treatment

December 18, 2023

In this cross-sectional study, Black patients were nearly 5 times more likely to be diagnosed with disseminated manifestations of Lyme disease (LD), which is associated with more significant, prolonged morbidity. They were also more likely to experience longer time to appropriate treatment (median 35 days vs. 7 days) compared with White patients.

• The final sample conducted at a specialty clinic in suburban Maryland included 1,395 patients, of which 703 (50.4%) were men with a median age of 48 years.
• Researchers classified initial LD presentations as as erythema migrans (EM) only; disseminated neurologic, cardiac, or joint disease; or symptoms only, without objective signs.
• Racial distributions were examined across groups.
• After controlling for age and gender, Black patients had 4.93 times the odds of disseminated disease (95% CI, 2.02-12.02; P < .001) compared with the EM-only group (949 patients).
• Men independently also had higher odds of disseminated disease (OR, 1.61; 95% CI, 1.20-2.15; P = .001).
• Among 1,325 patients, Black patients (OR, 2.07; 95% CI, 1.12-3.84; P = .02), women (OR, 1.39; 95% CI, 1.09-1.77; P = .007), and younger age (per 10 years: OR, 1.12; 95% CI, 1.04-1.20; P = .002) all independently had higher odds of being in the symptoms-only group.
• Overall, Black patients had a significantly longer median (IQR) time to appropriate antibiotic treatment (35 [6-119] days) compared with White patients (7 [0-70] days) (1,259 patients; P = .01). This was significant among patients with EM (Black, 26 [6-36] days; White, 4 [0-14] days; P = .05) but not those with disseminated disease or symptoms only.
• Initial inappropriate antibiotics were found in 6 of 37 Black patients (16.2%) and 90 of 1,165 White patients (7.7%) (P = .06).
• Study authors note that EM images on Black patients are underrepresented in medical education materials; gaps in health care access, racial discrimination, and implicit bias also contribute to EM underrecognition.

Source:

Starke S, et al. (2023, December 1). JAMA Netw Open. Time to Diagnosis and Treatment of Lyme Disease by Patient Race. https://pubmed.ncbi.nlm.nih.gov/38085545/