American Journal of Epidemiology, Vol 152, Issue 8 756-759, Copyright © 2000 by Oxford University Press
AD Fix, CA Pena and GT Strickland
In the United States, the incidence of Lyme disease is considered to be
disproportionately high among Whites because of risk of exposure. For
assessment of racial differences in Lyme disease incidence and the role of
risk exposure, incidence rate ratios (IRRs) for Lyme disease and its
manifestations between Whites and African Americans in Maryland and in its
focus of endemicity, the Upper Eastern Shore, were calculated. Calculations
were based on reported cases of Lyme disease in Maryland during the years
1992-1996. The IRR for Lyme disease between Whites and African Americans
was 6.3 (95% confidence interval (CI): 5.0, 8.0), decreasing to 1.8 (95%
CI: 1.2, 2.7) for the Upper Eastern Shore. Statewide, there was a
significant difference between the White to African American IRR for
erythema migrans and for Lyme disease- associated arthritis, at 17.7 (95%
CI: 11.2, 27.8) and 2.3 (95% CI: 1.7, 3.2), respectively. On the Upper
Eastern Shore, the IRR for arthritis reversed, indicating higher incidence
among African Americans than among Whites: IRR = 5.7 (95% CI: 2.4, 13.9)
for erythema migrans and IRR = 0.7 (95% CI: 0.4, 1.1) for arthritis. White
patients were more likely to have erythema migrans (risk ratio = 2.8, 95%
CI: 1.9, 4.1) and less likely to have arthritis than were African Americans
(risk ratio = 0.4, 95% CI: 0.3, 0.5). Among all patients, there was a
significant negative association between arthritis and erythema migrans.
Although much of the racial disparity in incidence rates diminishes in a
rural, endemic area, consistent with exposure risk being responsible for
much of the variation, a difference remains. This may be due to failure to
recognize early disease (erythema migrans) among African Americans,
resulting in increased rates of late manifestations. Geographic spread of
the disease warrants efforts to increase awareness of Lyme disease and its
manifestations among people of color and the health care providers who
serve them.
Racial differences in reported Lyme disease incidence [In Process Citation]
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
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  I. El-Shanawany, R. Liebling, K. Roue, P. Jeffery, I. Robbe, A. D. Fix, G. T. Strickland, and C. A. Pena RE: "RACIAL DIFFERENCES IN REPORTED LYME DISEASE INCIDENCE" Am. J. Epidemiol., April 1, 2001; 153(7): 718 - 718. [Full Text] [PDF]
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