Black children more likely to be diagnosed later with Lyme disease

A recently published study confirms previous findings that black children are more likely to be diagnosed later with Lyme disease compared to other races.

One study found black patients with Lyme disease were more likely to present with disseminated disease. The authors suggested, “This may be due to failure to recognize early disease (erythema migrans) among African Americans, resulting in increased rates of late manifestations.”¹

Ly reported similar results using 2015–2016 claims data sample of 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 found that black adults were 4 times more likely to present with disseminate Lyme disease than with a rash.

In their study “Racial differences in the diagnosis of Lyme disease in children,” Hunt and colleagues reported similar results in black children.³ The authors described a prospective cohort study at 8 emergency departments between June 2015 and August 2022 undergoing clinical evaluation for Lyme disease. The median age of the 4003 enrolled children was 8 years of age. Of these children, 485 (12.3%) were black, 3075 (77.9%) white, 96 (2.4%) Asian, and 288 (7.3%) other races.

They found that black children were more likely to present with a swollen joint on examination rather than a skin lesion.

The authors discussed 3 potential reasons to explain why black children were diagnosed later with Lyme disease.

1. Skin lesions may be more difficult to recognize in black children.
2. Black children may have different clinical presentations.
3. “The influences of factors such as bias, racial discrimination, socioeconomic status, and access to care are likely to play a role given their ubiquity across medicine.”

The authors advised, “Improving education and guidelines around Lyme diagnosis across different skin types is warranted to reduce disparities in Lyme disease diagnosis.”