Racial Disparity in Lyme Diagnosis & Treatment

JAMA Network Open (Starke, SJ, et al.) 12.12.2023, published online “Time to Diagnosis and Treatment of Lyme Disease by Patient Race.” Investigators found that Black patients were more likely to be diagnosed with disseminated manifestations and experience longer time to appropriate treatment. This is one of the few large studies of racial differences in Lyme disease in an academic setting and is consistent with findings of prior surveillance and insurance claims studies.

In this cross sectional study, researchers analyzed data from 1395 patients with suspected untreated or post treatment Lyme disease from suburban Maryland. Demographic and clinical information was collected at time of diagnosis or extracted from prior medical records.

Lyme disease presentations were classified in 3 categories: erythema migrans (EM) only; disseminated neurologic, cardiac, or joint disease; or symptoms only. The racial distribution of patients was then examined across groups using χ2 or Fisher exact tests. The most marked differences were seen among Black patients. Black patients experienced a significantly longer median time to receiving appropriate antibiotic treatment compared with White patients. This was especially significant among patients with EM only. It was also found that initial inappropriate antibiotics were provided to 6 of 37 Black patients and 90 of 1165 White patients.

Of note is the relatively small number of Black patients in the study sample. There is underrepresentation of EM images of Black patients in medical education materials, gaps in health care access among black patients, racial discrimination, and implicit bias contributing to under-recognition of EM in black patients. Efforts are needed to increase both patient and clinician awareness to ensure early and accurate diagnosis and treatment across this patient population.

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For More Information: 

Read the Full Text JAMA Network Open Article

Read LDA’s Post: Lyme Disease Manifestation In Children of Different Races