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Lyme disease possibly underdiagnosed in Hispanics despite potentially increased risk
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Additional research is needed to determine if there are underlying factors explaining why Lyme disease is less frequently diagnosed in Hispanics living in the United States, despite a potentially greater risk of job-related exposure, according to recent data.
The annual incidence of reported cases of Lyme disease among Hispanics was just 0.8 per 100,000 people compared with 4.0 cases per 100,000 among non-Hispanics, researchers wrote in Emerging Infectious Diseases
“Inadequate health care access, language barriers, and lack of (Lyme disease) awareness could cause both underdiagnosis and delays in diagnosis in the Hispanic population,” the researchers wrote.
The study included 374,338 confirmed and probable cases of Lyme disease from the CDC’s National Notifiable Disease Surveillance System between 2000 and 2013. Of the 148,444 cases where ethnicity was available, 5,473 people self-identified as Hispanic.
Researchers found the epidemiology of Lyme disease among Hispanics — including bimodal age distribution, slight predilection in males and clustering in states where the disease is regularly found — was similar to that of the rest of the population.
However, they also found that Hispanics with Lyme disease were significantly more likely to have signs of disseminated infection and symptom onset during fall months, though it is unknown if this results from delays in medical care or other factors like seasonal outdoor labor patterns.
Figure 1. This is a blacklegged tick (Ixodes scapularis), one of the most common vectors of Lyme disease.
Source: Gary Alpert, Harvard University, Bugwood.org
According to the researchers, approximately 9 million Hispanics live in the 13 states where Lyme disease is most common, and in the United States, Hispanics comprise 43.6% of grounds maintenance workers and 43.4% of workers in the farming, fishing and forestry industries, occupations with a high risk for tick exposure. Because outdoor workers in Lyme disease-endemic areas have a substantially higher rate of Lyme disease seropositivity, Hispanics in these areas are at greater risk for infection while on the job, researchers said.
However, the researchers also noted urban areas have larger proportions of Hispanics than the overall US population, so their risk of Lyme disease might be reduced, they said.
Just 58.5% of Hispanics had health insurance during 2009 to 2013, compared to 84.9% of non-Hispanic whites, according to the researchers. Further, 15.5% of Hispanics reported either delaying or avoiding needed medical care because of cost concerns.
The researchers said it is essential to reach at-risk populations, such as Hispanics, with culturally and linguistically appropriate prevention education.
“Although some educational materials about prevention of tickborne diseases have been translated into Spanish, additional translations and modifications to address cultural differences would be helpful,” they wrote. “Furthermore, targeted educational campaigns could enhance use of these materials and improve the reach, retention and overall impact of prevention education.” – by Gerard Gallagher
Disclosures: The researchers report no relevant financial disclosures.
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