From 2007 to 2016, private insurance claim lines with diagnoses of Lyme disease increased 185 percent in rural areas and 40 percent in urban areas, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Delving into its database of over 23 billion privately billed healthcare claims, FAIR Health uncovered new findings about this common, tick-borne, bacterial illness.

Lyme disease-A growing concern/Fair Health
Lyme disease-A growing concern/Fair Health

Rural and Urban Differences
FAIR Health data from the period 2007-2016 confirm findings by the Centers for Disease Control and Prevention (CDC) that summer is the peak period for Lyme disease diagnoses, as reflected in claim lines with such diagnoses. But rural and urban areas differ. In June and July, claim lines with Lyme disease diagnoses were more common in rural than urban settings. But in the winter and early spring months (December through April), claim lines with Lyme disease diagnoses were reported more often in urban than rural settings.

Age also was a difference between rural and urban settings. In rural settings, claim lines with Lyme disease diagnoses were more common for middle-aged and older people: individuals aged 41 years and above accounted for 62 percent of the rural diagnoses. But, in urban populations, younger individuals accounted for a higher percentage of claim lines with Lyme disease diagnoses.

Spread of Lyme Disease
Although Lyme disease historically has been concentrated in the Northeast and upper Midwest, FAIR Health data suggest that it is spreading geographically. In 2007, claim lines with diagnoses of Lyme disease as a percentage of all claim lines with all diagnoses in the state were highest in the Northeast. The top states, from highest to lowest, were New JerseyRhode IslandConnecticutMassachusetts and New York. But, in 2016, the top states, from highest to lowest, were Rhode IslandNew JerseyConnecticutNorth Carolina and New York—with the emergence of North Carolinasuggesting significant expansion to a new region.

Lyme Disease and Later Diagnoses
Lyme disease is treatable with antibiotics, but some patients go on to develop post-treatment Lyme disease syndrome (PTLDS), sometimes called chronic Lyme disease, with long-term symptoms such as fatigue, muscle and joint pain and cognitive issues. Autoimmunity has been suggested as a factor in PTLDS. FAIR Health performed a retrospective longitudinal study, examining private insurance claims from a statistically significant cohort of individuals from 2013 to 2017. For patients who had a Lyme disease diagnosis, the most prevalent subsequent diagnoses were:

  • Joint pain (e.g., dorsalgia, low back pain, hip and knee pain);
  • General symptoms of chronic fatigue and other fatigue;
  • Soft tissue disorders (e.g., myalgia, neuralgia, fibromyalgia); and
  • Hypothyroidism.

Across age groups, patients with Lyme disease were generally more likely to develop these apparently associated diagnoses than all patients in the cohort. Since these diagnoses often have an autoimmune component, FAIR Health data suggest that at least some autoimmune diagnoses correlate with Lyme disease.

FAIR Health President Robin Gelburd commented: “Lyme disease is growing as a public health concern. As steward of the nation’s largest repository of healthcare claims, FAIR Health offers its data to advance the state of knowledge about this disease.”