Who Is Really at Higher Risk for Lyme Disease?
Lyme disease risk is not the same for everyone
Children and older adults repeatedly show higher rates
Gardening, walking, outdoor work, pets, and everyday environments can all shape opportunities for tick exposure
Who is really at higher risk for Lyme disease? The simplest answer is that people with more opportunities to encounter infected ticks are generally at greater risk. But epidemiology shows that Lyme disease risk is more complicated than simply making a list of high-risk groups.
Studies repeatedly identify young children and older adults as having higher rates of Lyme disease. Men often have higher reported rates than women, and outdoor activity, occupation, geography, season, residential environment, and interactions with animals can all influence opportunities for tick exposure.
A 2026 scoping review of 32 German studies identified associations involving age, sex, occupation, time outdoors, rural residence, geography, season, education, pet ownership, and other factors.1 A 2024 study of 7,762 reported Lyme disease cases in Ontario, Canada, found incidence peaks among children ages 5–9 and adults ages 50–79 and provided additional information about where people were exposed and which preventive behaviors they reported using.2
These findings are consistent with a large U.S. surveillance study showing the familiar Lyme disease pattern of higher incidence among children and older adults.3
A separate 2024 report broadened the question further. Rather than concentrating primarily on demographics, Kim and colleagues examined occupational exposure, outdoor activities, pet and animal interactions, prevention behavior, and geographic patterns of tick-borne disease.4
As a physician and epidemiologist, I think an important lesson from this research is that a risk factor is not necessarily a cause. A characteristic may identify people who are more likely to encounter ticks without itself making that person biologically more susceptible to Lyme disease.
What Does It Mean to Be at Higher Risk for Lyme Disease?
For Lyme disease to develop, several events generally have to occur. A person must enter an environment where ticks are present, encounter a tick capable of transmitting Borrelia, be bitten by an infected tick, and then become infected.
This means Lyme disease risk can be thought of as a pathway rather than a single characteristic.
For example, forestry work may be associated with Lyme disease not because forestry workers are inherently more susceptible to Borrelia, but because they spend considerably more time in environments where ticks are present.
The same reasoning may apply to gardening, hiking, walking through wooded areas, outdoor recreation, rural residence, pet ownership, and some of the demographic associations reported in epidemiologic studies.1,4
Understanding how Lyme disease is acquired helps explain why exposure is such an important part of interpreting these risk factors.
Why Does Lyme Disease Peak in Children and Older Adults?
Age is one of the most consistent patterns in Lyme disease epidemiology.
In the 2024 Ontario study, the average annual incidence was 7.2 cases per 100,000 among children ages 5–9. Rates then increased again later in adulthood, reaching 9.2 per 100,000 among adults ages 50–59, 11.8 among those ages 60–69, and 10.8 among those ages 70–79.2
The German scoping review found a similar pattern. Across the literature examined by the authors, young children approximately 3–9 years old and adults approximately 50–79 years old repeatedly appeared among higher-risk groups.1
Large U.S. surveillance data also demonstrate this bimodal age distribution. Kugeler and colleagues examined confirmed Lyme disease cases reported in the United States from 1992 through 2016. Children ages 5–9 were consistently among the most affected groups, while the adult peak shifted toward older ages over time.3
These patterns do not prove that age itself causes susceptibility. Different age groups may have different outdoor activities, environments, clothing, prevention practices, and opportunities for tick exposure.
For younger patients, more information about presentation and diagnosis is available in my guide to pediatric Lyme disease.
Are Men at Higher Risk for Lyme Disease Than Women?
Many studies report higher Lyme disease rates among males, but the reason is not necessarily biological.
In the Ontario study, 56.3% of reported cases were male and 43.3% were female. The average annual incidence was 7.6 per 100,000 among males compared with 5.7 among females.2
Male case-patients were also more likely than female case-patients to report participating in activities in wooded or tall-grass areas.2
The U.S. study by Kugeler and colleagues similarly found a male predominance across most age groups. Over the 25-year study period, increases in Lyme disease incidence were disproportionately greater among males.3
However, sex differences in Lyme disease rates could reflect differences in occupation, outdoor activity, clothing, recreational behavior, tick exposure, healthcare-seeking behavior, symptom recognition, or other factors.
The German review illustrates this uncertainty particularly well. Although most studies reporting a significant sex association pointed toward greater risk among males, some studies found greater risk among females.1
Being male should therefore be viewed as an epidemiologic association rather than proof of greater biological susceptibility to Borrelia.
Does Spending More Time Outdoors Increase Lyme Disease Risk?
Yes. Increased opportunity for tick exposure is one of the easiest risk associations to understand epidemiologically.
In the German review, one study found that spending one to three hours outdoors nearly doubled the odds of reporting a tick bite. Another found that Lyme disease risk increased with the number of days spent outdoors.1
Outdoor occupations also showed consistent associations. Forestry workers, agricultural workers, military personnel, and other people working outdoors were among the groups reported to have increased Lyme disease risk.1
Among forestry workers, one study found that having 50 or more tick bites over the course of a career was associated with approximately twice the odds of Lyme borreliosis.1
The 2024 Kim report similarly identified outdoor occupations as an important component of tick-borne disease risk assessment and emphasized that exposure patterns should be considered alongside demographic characteristics.4
This is a good example of why I would interpret occupation primarily as an exposure marker. The occupation itself is probably less important than what it tells us about repeated contact with tick habitat.
Can Gardening or Walking Lead to Tick Exposure?
Yes. Tick exposure does not require an expedition into deep woods.
The literature reviewed by Kim and colleagues included studies linking tick encounters with ordinary outdoor activities, including walking on wooded pathways and gardening.4
This matters clinically because patients may answer “no” when asked whether they have been hiking or camping even though they regularly garden, do yard work, walk a dog, use neighborhood trails, visit parks, or spend time along wooded edges.
Those activities do not mean someone will develop Lyme disease. They simply create additional opportunities to encounter ticks when the activity occurs in an environment where ticks are present.
This is why an exposure history may need to go beyond the question, “Have you been hiking?”
Do You Have to Be Hiking or Camping to Get Lyme Disease?
No. The Ontario study demonstrates that reported Lyme disease exposures were not limited to wilderness activities.
Among case-patients who voluntarily provided information about specific exposure locations, the most commonly reported setting was a secondary residence or cottage. Primary residences and the homes of friends or relatives were also frequently reported.2
Parks, camping areas, hiking or cycling trails, and conservation areas accounted for smaller proportions of the reported exposure locations.2
This does not mean that homes or cottages are inherently more dangerous than hiking trails. The study included people who already had reported Lyme disease and did not compare them with an uninfected control group.
But the findings reinforce an important practical point: Lyme disease exposure can occur during ordinary activities around homes, yards, recreational properties, parks, and neighborhoods—not just during hiking or camping trips.
For more on household exposure, see Can You Get Lyme Disease in Your Own Yard?
Does Living in a Rural Area Increase Lyme Disease Risk?
Several studies suggest that it can.
One study in the German review found that rural residence nearly doubled the odds of experiencing a tick bite. Four studies associated rural residence with greater Lyme disease risk, including one analysis reporting an odds ratio of 1.61.1
Again, residence may function as a marker for exposure. Rural areas can provide greater access to forests, brush, leaf litter, wildlife, and other environments capable of supporting ticks.
But Lyme exposure is not limited to remote forests. The Ontario findings reinforce that ticks may also be encountered around homes, cottages, parks, trails, and other green spaces.2
Risk should therefore not be dismissed simply because someone does not remember hiking deep in the woods.
Does Local Geography Matter?
Yes, but geographic findings need careful interpretation.
Kim and colleagues mapped reported tick-borne disease incidence across Illinois counties and compared those patterns with county-level characteristics including agricultural land, forest cover, park accessibility, and education.4
The mapping showed regional differences in reported tick-borne diseases. Lyme disease and anaplasmosis had different geographic patterns from ehrlichiosis and spotted fever group rickettsiosis.4
However, these were county-level ecological comparisons. They do not establish that living near a park, forest, or agricultural area caused an individual person’s infection.
Instead, the analysis illustrates why local geography may help public health officials identify communities where more detailed surveillance, prevention, and education could be useful.
How Often Were People With Lyme Disease Using Tick Prevention?
The Ontario study also examined preventive behaviors reported by Lyme disease case-patients.
Among those who answered the prevention questions, fewer than one-third reported checking themselves for ticks. Roughly one-quarter reported using repellent, and a similar proportion reported wearing adequate protective clothing.2
Preventive behaviors were relatively uncommon overall and did not differ substantially by sex.2
These findings should be interpreted carefully. The study did not compare infected people with an uninfected control group, so it cannot tell us how much any particular preventive behavior reduced the likelihood of developing Lyme disease.
It also cannot establish that people became infected because they failed to perform a tick check, use repellent, or wear protective clothing.
What the study does show is that many people who ultimately developed reported Lyme disease were not consistently using these preventive measures.
My overview of Lyme disease prevention discusses practical strategies for reducing tick exposure.
Does the Time of Year Affect Lyme Disease Risk?
Yes. Season is another recurring epidemiologic pattern.
In the German studies, activity of Ixodes ricinus commonly peaked in May and June, while reported Lyme disease cases generally peaked in July and occurred predominantly between June and September.1
For example, one Bavarian surveillance study found that 58.6% of Lyme disease cases occurred from June through August. Other large surveillance studies found approximately 60% to 70% of cases occurring from June through September.1
The exact seasonal pattern differs by region, climate, tick species, and life stage. The broader epidemiologic point is that Lyme disease risk changes over time as tick activity and human outdoor activity change.
Do Pets Increase the Risk of Lyme Disease?
The evidence is mixed, but pets can be relevant to an exposure history.
Some studies in the German review associated pet ownership, particularly cat ownership, with greater odds of Borrelia infection. However, other studies found no association between pet ownership and Lyme disease risk.1
The authors raised the possibility of confounding. Pet ownership may identify households whose members spend more time outdoors or live in environments with greater tick exposure rather than demonstrating that the pet itself is responsible for infection.1
Kim and colleagues also identified pet ownership and interactions with animals as factors associated with tick-borne disease exposure in the literature they reviewed.4
Outdoor pets can encounter ticks and potentially carry ticks into the household environment. But that possibility should not be confused with evidence that owning a dog or cat directly causes Lyme disease.
The Ontario study adds another observation: reported sharing of living space with companion animals that spent time outdoors decreased with increasing age.2 Again, that association does not establish whether pets increased or decreased anyone’s Lyme disease risk.
An association can point us toward an exposure pattern without proving the mechanism behind it.
Why Would Higher Education Be Associated With Lyme Disease?
This is one of the more interesting findings in the epidemiologic literature.
Two Lyme studies in the German review found greater odds of infection among people with higher levels of education, while another study found lower socioeconomic status to be associated with lower risk.1
It would be a mistake to conclude that education itself increases biological susceptibility to Lyme disease.
A more plausible explanation is that education and socioeconomic status may correlate with other behaviors or circumstances, such as recreational activities, home environment, travel, gardening, hiking, or the amount of leisure time spent outdoors. The German review authors similarly suggest that greater outdoor exposure could contribute to this association.1
Education can also work in another direction. Kim and colleagues reviewed research suggesting that greater knowledge about ticks is associated with greater adoption of preventive behaviors.4
These findings illustrate a fundamental problem in observational epidemiology: the same variable may be connected to several behaviors, exposures, and outcomes. A statistical association does not necessarily identify the underlying mechanism.
Tick Bites, Lyme Antibodies, and Lyme Disease Are Not the Same Outcome
This remains one of the most important limitations to understand when reading risk-factor studies.
The 32 studies in the German review were heterogeneous. Some measured tick bites. Others measured antibodies against Borrelia. Others counted diagnosed Lyme disease cases. Still others examined tick abundance or the prevalence of pathogens in ticks.1
Those outcomes should not be treated as interchangeable.
A tick bite establishes exposure to a tick but does not establish infection. Borrelia antibodies provide evidence of an immune response to exposure but do not by themselves establish when the exposure occurred or whether a person currently has active Lyme disease. A reported Lyme disease diagnosis introduces additional issues involving case definitions, recognition, testing, and healthcare access.
Similarly, finding more ticks in an environment does not tell us exactly how many people in that environment will develop Lyme disease.
As an epidemiologist, I would therefore be cautious about reducing this literature to a simple ranking of who is “most likely” to get Lyme disease.
What Are the Limitations of These Studies?
All four sources used here have limitations that matter when translating population-level findings to an individual patient.
The German paper was a scoping review rather than a meta-analysis. The researchers mapped the available evidence but did not combine the studies to calculate a single numerical estimate for each risk factor. The included studies differed substantially in design, population, location, and outcome, and the review did not conduct a formal critical quality appraisal of each study.1
The Ontario study was based on reported Lyme disease cases rather than a comparison between infected and uninfected people. Information about risk factors and preventive behaviors was also incomplete because not every case-patient answered those questions.2
Therefore, the Ontario study can describe how reported Lyme disease cases differed by age and sex and what behaviors they reported, but it cannot establish that a particular behavior caused or prevented infection.
The Kim paper was a brief report combining a targeted literature review with ecological mapping of Illinois county-level data.4 Its maps are useful for generating and illustrating public health hypotheses, but county characteristics such as forest cover, agricultural land, park access, or educational attainment should not be interpreted as proof of an individual’s exposure or cause of infection.
Geography matters as well. The German findings come from Europe, where Ixodes ricinus is an important vector, while the Ontario study reflects Canadian surveillance. Exact numerical estimates should not simply be transferred to the United States.
However, the large U.S. analysis by Kugeler and colleagues independently demonstrates a similar age and sex pattern, including the persistent peak among children ages 5–9 and higher incidence among males across most age groups.3
What Does This Mean for Patients?
I would focus less on whether someone belongs to a particular demographic category and more on the circumstances surrounding possible tick exposure.
Where was the person? What time of year was it? How much time did they spend outdoors? What type of environment were they in? Did they garden, do yard work, walk a dog, use parks or trails, or work outdoors? Did their occupation or recreational activities repeatedly place them in tick habitat? Do they live in or travel to an area where Lyme disease is established?
And importantly: did exposure potentially occur around a home, yard, cottage, park, workplace, or other everyday environment rather than during an obvious wilderness activity?
These questions can be more useful clinically than assuming someone is at low risk because they do not fit a stereotypical profile.
Risk also does not disappear simply because preventive measures were used. Prevention can reduce exposure, but no strategy eliminates every tick bite.
Frequently Asked Questions
Who has the highest risk of getting Lyme disease?
People with greater exposure to infected ticks are generally at higher risk. Epidemiologic studies repeatedly identify young children, older adults, outdoor workers, people who spend substantial time outdoors, and residents of higher-risk geographic areas. These characteristics often reflect differences in tick exposure rather than biological susceptibility alone.
Why does Lyme disease peak in children and older adults?
Lyme disease repeatedly shows higher incidence among young children and older adults. Differences in outdoor activities, environment, behavior, prevention practices, and opportunities for tick exposure may contribute. U.S., Canadian, and European studies have all described this general age pattern.1-3
Are men more likely to get Lyme disease?
Many surveillance studies report higher Lyme disease rates among males. However, this does not prove that males are biologically more susceptible. Differences in outdoor activity, occupation, exposure, prevention behavior, healthcare use, and other factors may contribute.1-3
Can you get a tick bite while gardening or walking?
Yes. Research reviewed by Kim and colleagues included tick encounters associated with activities such as gardening and walking on wooded pathways. Tick exposure can occur during routine outdoor activities and does not require hiking deep in the woods.4
Do you have to hike or camp to get Lyme disease?
No. Tick exposure can occur around homes, yards, cottages, parks, trails, workplaces, and other green spaces. In the Ontario study, many reported exposure locations involved primary or secondary residences rather than hiking or camping areas.2
Can pets increase tick exposure?
Pets that spend time outdoors can encounter ticks and may bring ticks into the household environment. Some studies associate pet ownership with greater tick or Lyme disease exposure, while others do not. Pet ownership may also be a marker for greater outdoor activity or residence in tick habitat rather than a direct cause of infection.1,4
Does living in the country increase Lyme disease risk?
Several studies associate rural residence with greater tick-bite or Lyme disease risk. However, ticks can also be encountered in suburban yards, parks, trails, and other green spaces, so living outside a rural area does not eliminate risk.
Are outdoor workers at higher risk for Lyme disease?
Yes. Forestry workers, agricultural workers, military personnel, and other people with substantial occupational outdoor exposure have repeatedly been identified as higher-risk groups. Increased opportunity for contact with ticks is a likely explanation.1,4
Does having a risk factor mean I will get Lyme disease?
No. A risk factor describes an association with a greater probability of an outcome. It does not mean an individual will develop Lyme disease, and it does not necessarily mean the factor itself causes the increased risk.
Clinical Takeaway
Research from Germany, Canada, and the United States reinforces several familiar Lyme disease risk patterns: young children and older adults frequently have higher rates, males often have higher reported incidence, outdoor exposure matters, and Lyme disease follows strong geographic and seasonal patterns.1-3
The 2024 Kim report strengthens an important additional point: risk assessment should look beyond demographic categories and consider what people actually do and where exposure may occur.4 Outdoor work, gardening, walking, recreation, pets and animal interactions, and local environmental conditions can all provide clues about opportunities for tick exposure.
But epidemiology also teaches us to be careful. Tick bites, Borrelia antibodies, diagnosed Lyme disease, and tick abundance are different outcomes. Likewise, an association with age, sex, education, pet ownership, occupation, or geography does not establish that the characteristic itself causes Lyme disease.
The most useful way to think about Lyme disease risk is not simply who a person is, but how, where, when, and how often that person may have been exposed to infected ticks.
Related Articles
These articles provide additional information about tick exposure, Lyme disease risk, prevention, and recognizing everyday opportunities for tick encounters:
Can You Get Lyme Disease in Your Own Yard?
How Do You Get Lyme Disease? Ticks, Transmission, and Hidden Risks
Lyme Disease Prevention: What Works and What Doesn’t
Why Tick Bite Prevention for Kids Is So Difficult
References
- Schlupp C, Belau MH. Risk Factors for Tick-Borne Diseases in Germany: A Scoping Review. Zoonoses Public Health. 2026;73(4):297–313. doi:10.1111/zph.70060. PMID: 41947389. PMCID: PMC13144437.
- Adams JA, Osasah V, Paphitis K, et al. Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. Emerg Infect Dis. 2024;30(10):2006–2015. doi:10.3201/eid3010.240191. PMID: 39320128. PMCID: PMC11431918.
- Kugeler KJ, Mead PS, Schwartz AM, Hinckley AF. Changing Trends in Age and Sex Distributions of Lyme Disease—United States, 1992–2016. Public Health Rep. 2022;137(4):655–659. doi:10.1177/00333549211026777. PMID: 34185610. PMCID: PMC9257499.
- Kim P, Maxwell S, Parijat N, Kim D, McNeely CL. Targeted Tick-Borne Disease Recognition: Assessing Risk for Improved Public Health. Healthcare (Basel). 2024;12(10):984. doi:10.3390/healthcare12100984. PMID: 38786395. PMCID: PMC11121250.
This article is for educational purposes and is not a substitute for individualized medical evaluation, diagnosis, or treatment.
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
