A major new study analyzing more than 168,000 Lyme disease cases has uncovered troubling disparities in diagnosis and outcomes across racial lines. The research, published in Emerging Infectious Diseases, shows that non-White patients consistently face worse outcomes than White patients. These findings highlight the urgent need to address Lyme disease racial disparities in the healthcare system.

Lyme Disease Racial Disparities by the Numbers

Researchers examined Medicare and Medicaid data from 16 high-incidence states between 2016–2021. The disparities were striking:

• Non-White children were 77% more likely to develop severe, disseminated disease.

• Black children faced 96% higher hospitalization rates.

• 43% of Black Medicare patients under 65 presented with advanced disease.

• Non-White patients were more often diagnosed outside peak tick season, suggesting delayed recognition.

These racial disparities reveal how systemic bias and missed recognition contribute to worse outcomes.

Rash Recognition and Lyme Disease Racial Disparities

The hallmark sign of Lyme disease—the erythema migrans (“bull’s-eye”) rash—appears in up to 80% of cases. But on darker skin tones, the rash is more difficult to detect.

When the rash is overlooked, patients are more likely to develop serious complications affecting the nervous system, heart, and joints. These later-stage cases often require hospitalization and complex treatment. The inability to recognize the rash across diverse skin tones is one of the most visible drivers of racial disparities.

A Broken Diagnostic Journey

The study also exposed troubling diagnostic patterns for non-White patients:

• More emergency department visits rather than primary care.

• Multiple “sick visits” before the correct diagnosis.

• Higher rates of diagnostic testing, reflecting physician uncertainty.

• Different antibiotic prescribing patterns.

This journey illustrates how Lyme racial disparities extend beyond initial recognition, affecting the entire course of care.

Systemic Drivers of Lyme Disease Racial Disparities

The issue is not just rash visibility—systemic factors also play a critical role:

• Provider education gaps — Many clinicians lack training in identifying Lyme symptoms on darker skin tones.

• Quality of care differences — Despite having insurance, non-White patients still experienced diagnostic delays.

• Seasonal bias — Physicians diagnosed non-White patients outside peak tick season more often, pointing to gaps in knowledge.

These systemic issues amplify Lyme disease racial disparities and delay effective treatment.

The Human Cost of Lyme Disease Racial Disparities

Behind these statistics are real patients facing preventable complications. Late-stage disease carries a much higher risk of persistent post-treatment Lyme disease syndrome (PTLDS)—a condition marked by chronic fatigue, joint pain, and cognitive impairment.

For many, what should have been resolved with a short antibiotic course becomes months or years of debilitating illness. This is the human cost of Lyme racial disparities.

Addressing Racial Disparities in Care

The study’s findings demand immediate action:

• Enhanced clinician training on recognizing Lyme disease across all skin tones.

• Improved screening protocols in endemic areas.

• Targeted prevention programs for diverse communities.

• Quality improvement initiatives to reduce diagnostic delays.

Effective treatment exists—but only if patients are diagnosed promptly. Reducing Lyme disease racial disparities is critical to preventing needless suffering.

Moving Forward

This study, one of the largest analyses of Lyme disease to date, provides clear evidence that systemic changes are needed. As Lyme disease continues to spread geographically, equitable care is not optional—it is essential.

Addressing Lyme disease racial disparities is about more than numbers—it’s about ensuring every patient has a fair chance at early diagnosis, effective treatment, and recovery.

Links

1. Paper –Gould LH, Willis SJ, Prener CG, et al. Differences in Lyme Disease Diagnosis among Medicaid and Medicare Beneficiaries, United States, 2016–2021. Emerg Infect Dis. 2025;31(9).
2. CDC Lyme Disease Overview
3. Lyme Science blog – Black children more likely to be diagnosed later with Lyme disease
4. Lyme Science blog –Could race affect the diagnosis and treatment of Lyme disease?