Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States

Background Clinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology. Methods Patients from high-incidence states treated for LD during 2005-2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations. Results Among 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10-14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0-4.2), facial palsy (OR, 2.1; 95% CI, 1.6-2.7) and carditis (OR, 2.4; 95% CI, 1.6-3.6) in males aged 20-24 years, and meningitis in females aged 10-14 years (OR, 3.4; 95% CI, 2.1-5.5) compared to the 55-59 year referent age group. Males aged 15-29 years had the highest risk for complete heart block, a potentially fatal condition. Conclusions The risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management.