Risk Factors and Outcomes of Treatment Delays in Lyme Disease: A Population-Based Retrospective Cohort Study

Frontiers in Medicine

article

Annemarie G. Hirsch¹  Melissa N. Poulsen¹  Cara Nordberg¹  Katherine A. Moon²  Alison W. Rebman³  John N. Aucott³  Christopher D. Heaney²  Brian S. Schwartz¹ 

[1] Department of Population Health Sciences, United States;Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, United States;Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, United States;Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, United States;Department of International Health, Johns Hopkins University Bloomberg School of Public Health, United States

关键词: Lyme disease;    treatment delays;    post-treatment Lyme disease syndrome;    time-to-treatment;    disparities;   

DOI  :  10.3389/fmed.2020.560018

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Longer time between symptom onset and treatment of Lyme disease has been associated with poor outcomes. Reducing time-to-treatment requires knowledge of risks for treatment delays. We conducted a population-based study to evaluate factors associated with delayed treatment of Lyme disease and the relation between delayed treatment and post-treatment Lyme disease syndrome (PTLDS). Methods: We mailed questionnaires to 5,314 individuals with a Lyme disease diagnosis or blood test followed by an antibiotic order in the medical record of a Pennsylvania health system from 2015 to 2017. Analyses were confined to 778 respondents who reported that they were treated for Lyme disease within the past 5 years and reported a rash and/or a positive blood test for Lyme disease. Time-to-treatment was calculated as the sum of two windows before and after seeking care for Lyme disease symptoms: time to first medical contact and time under care. We used logistic regression to evaluate factors associated with delayed time-to-treatment in each time window (>14 days vs. ≤14 days) and the association between total time-to-treatment (>30 days vs. ≤30 days) and PTLDS. We used inverse probability weighting to calculate estimates for the study's source population (5,314 individuals sent questionnaires). Results: In the source population, 25% had time to first contact >14 days, 21% had time under care >14 days, and 31% had a total time-to-treatment >30 days. Being uninsured and attributing initial symptoms to something other than Lyme disease were positively associated with delayed time to first medical contact, while seeking care at an urgent care or emergency setting (vs. primary care) was negatively associated. Diagnoses between November and April, and the absence of rash were positively associated with delays. Individuals whose treatment was delayed, defined as time-to treatment >30 days had 2.26 (95% confidence interval: 1.25, 4.05) times the odds of PTLDS as those who were treated within 30 days of symptom onset. Conclusions: In a population-based study in Pennsylvania, one-third of Lyme disease patients reported delayed treatment, which was associated with PTLDS. To improve Lyme disease outcomes, prevention efforts should aim to reduce the time before and after seeking care.

【 授权许可】

CC BY