Black Children More Likely to Be Diagnosed Later With Lyme Disease

Studies suggest that Black children may be more likely to receive a later diagnosis of Lyme disease compared with white children. Delayed recognition of early Lyme disease may contribute to higher rates of disseminated infection at the time of diagnosis.

One study found that Black patients with Lyme disease were more likely to present with disseminated disease. The authors suggested that this may occur because early Lyme disease—particularly the erythema migrans rash—may be more difficult to recognize in African American patients.¹

Ly reported similar findings using 2015–2016 claims data from Traditional Medicare beneficiaries. “Among Medicare patients, Black patients with Lyme disease appear to be diagnosed more often with disseminated disease on initial diagnosis compared to white patients, and they appear to be diagnosed more often outside of the months Lyme disease is most frequently diagnosed.”²

The study also found that Black adults were four times more likely to present with disseminated Lyme disease rather than an erythema migrans rash at the time of diagnosis.

In the study “Racial Differences in the Diagnosis of Lyme Disease in Children,” Hunt and colleagues reported similar findings in pediatric patients.³

The authors conducted a prospective cohort study of children evaluated for Lyme disease at eight emergency departments between June 2015 and August 2022. The median age of the 4,003 enrolled children was 8 years. Of these:

• 485 (12.3%) were Black
• 3,075 (77.9%) were white
• 96 (2.4%) were Asian
• 288 (7.3%) were classified as other races

Black children were more likely to present with a swollen joint rather than a characteristic Lyme rash.

This finding suggests that Lyme disease in Black children may be recognized later in the course of illness, when joint swelling or other manifestations of disseminated infection have already developed.

The authors discussed three possible explanations for the later diagnosis of Lyme disease in Black children:

1. Skin lesions such as erythema migrans may be more difficult to recognize in darker skin tones.
2. Black children may present with somewhat different clinical features.
3. Broader factors—including bias, racial disparities in healthcare, socioeconomic differences, and access to care—may influence the timing of diagnosis.

The authors concluded that improving clinician education and diagnostic guidelines across different skin types could help reduce disparities in Lyme disease diagnosis.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention