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Gould LH, Fathalla A, Moïsi JC, Stark JH. Racial and ethnic disparities in Lyme disease in the United States. Zoonoses Public Health 2024. [PMID: 38659178 DOI: 10.1111/zph.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Lyme disease (LD), caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. Although most surveillance-reported cases are in people who are White, data suggest worse outcomes among people from racial and ethnic minority groups. METHODS We conducted a systematic literature review to describe racial disparities in LD. We described the epidemiology of LD by race and ethnicity, including clinical presentation at diagnosis, and summarised the literature on knowledge, attitudes and practices related to LD and ticks by race and ethnicity. RESULTS Overall, the incidence and prevalence of LD were 1.2-3.5 times higher in White persons than in persons who identified as Asian or Pacific Islander and 4.5-6.3 times higher in White persons than in persons who identified as Black. Across multiple studies, people from racial and ethnic minority groups were more likely than White people to have disseminated manifestations of LD, including neurological manifestations and arthritis, and less likely to have erythema migrans. People from racial and ethnic minority groups were also more likely to report disease onset in the fall and less likely to report disease onset in the summer. Possible reasons for these disparities include lack of recognition of the disease in people with darker skin tones, lack of knowledge of disease risk for some groups and differences in exposure risk. CONCLUSIONS Taken together, these results reinforce that all people residing in high-incidence areas are at risk of LD, regardless of race or ethnicity. Future prevention measures should be broadly targeted to reach all at-risk populations.
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Affiliation(s)
- L Hannah Gould
- Global Medical Affairs, Vaccines and Antivirals, Pfizer Biopharma Group, New York, New York, USA
| | - Adam Fathalla
- Global Medical Affairs, Vaccines and Antivirals, Pfizer Biopharma Group, New York, New York, USA
| | - Jennifer C Moïsi
- Global Vaccines and Antivirals, Pfizer Biopharma Group, Paris, France
| | - James H Stark
- Global Vaccines and Antivirals, Pfizer Biopharma Group, Cambridge, Massachusetts, USA
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Hallas D, Spratling R. Methodologies to Advance Health Equity and Reduce Health Inequities in Nursing Research. J Pediatr Health Care 2024; 38:219-224. [PMID: 38429033 DOI: 10.1016/j.pedhc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
The Centers for Disease Control and Prevention affirm that health equity is only achieved when everyone has opportunities to attain full health potential without disadvantages related to social position or socially determined circumstances. To reduce health inequities in nursing research, researchers must increase diversity in study samples and ensure that study participants are representative of all populations in the United States. Identifying effective methods for recruiting underrepresented populations must be a thoughtful and reflective component of every research methodology. To achieve health equity in research studies, nurse researchers and clinicians must carefully plan ways to recruit study participants who represent all populations.
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Ogrinc K, Bogovič P, Maraspin V, Lotrič-Furlan S, Rojko T, Kastrin A, Strle K, Wormser GP, Strle F. Why Is the Duration of Erythema Migrans at Diagnosis Longer in Patients with Lyme Neuroborreliosis Than in Those without Neurologic Involvement? Pathogens 2024; 13:137. [PMID: 38392875 PMCID: PMC10893153 DOI: 10.3390/pathogens13020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/06/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
In prior studies, the skin lesion erythema migrans (EM) was present for a longer time period before diagnosis of concomitant borrelial meningoradiculoneuritis (Bannwarth's syndrome) compared to EM patients without neurologic symptoms. To determine if this observation pertains to other manifestations of Lyme neuroborreliosis (LNB), we compared EM characteristics in patients with borrelial meningoradiculoneuritis (n = 122) to those with aseptic meningitis without radicular pain (n = 72 patients), and to patients with EM but without neurologic involvement (n = 12,384). We also assessed factors that might impact duration. We found that the duration of EM at diagnosis in patients with borrelial meningoradiculoneuritis was not significantly different compared with those with LNB without radicular pain (34 vs. 26 days; p = 0.227). The duration of EM for each of these clinical presentations of LNB, however, was significantly longer than in patients with EM without LNB (10 days; p < 0.001). Contributing factors to this difference might have been that patients with LNB failed to recognize that they had EM or were unaware of the importance of not delaying antibiotic treatment for EM. In conclusion, the duration of the EM skin lesion in EM patients with LNB is longer than in patients with just EM, irrespective of the type of LNB.
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Affiliation(s)
- Katarina Ogrinc
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
| | - Vera Maraspin
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
| | - Stanka Lotrič-Furlan
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
| | - Tereza Rojko
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
| | - Andrej Kastrin
- Institute for Biostatistics and Medical Informatics, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Klemen Strle
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Tufts University, Boston, MA 02111, USA;
| | - Gary P. Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA;
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1525 Ljubljana, Slovenia; (K.O.); (P.B.); (V.M.); (S.L.-F.); (T.R.)
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McGowan D, Kermani A, Sheagren J. Investigating and Summarizing Information Resources Related to the Clinical Presentation and Diagnosis of Cutaneous Manifestations of Infectious Diseases in Patients With Skin of Color. Open Forum Infect Dis 2024; 11:ofad692. [PMID: 38390461 PMCID: PMC10883730 DOI: 10.1093/ofid/ofad692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024] Open
Abstract
Patients with skin of color (SOC) present diseases differently in many circumstances, yet there is a lack of information regarding the presentation and diagnosis of cutaneous manifestations in such patients experiencing infectious diseases. Therefore, we conducted a scoping review to investigate and summarize information pertaining to the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with SOC focusing on the following viral, bacterial, toxin-mediated, and infestation diseases and fungal infections: human immunodeficiency virus, shingles, impetigo, scarlet fever, Lyme disease, toxic shock syndrome, scabies, rickettsioses, and cutaneous fungal infections. This scoping review identified literature gaps regarding cutaneous manifestations of infectious diseases in patients with SOC such as a lack of visual examples and more precise descriptions of common infectious diseases. The lack of better-quality literature and educational resources describing cutaneous manifestations of infectious diseases in patients with SOC may contribute to care barriers; therefore, more research and collaboration are needed in the specialties of both infectious diseases and dermatology.
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Affiliation(s)
- Dorothea McGowan
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Anosh Kermani
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - John Sheagren
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Starke SJ, Rebman AW, Miller J, Yang T, Aucott JN. Time to Diagnosis and Treatment of Lyme Disease by Patient Race. JAMA Netw Open 2023; 6:e2347184. [PMID: 38085545 PMCID: PMC10716730 DOI: 10.1001/jamanetworkopen.2023.47184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
This cross-sectional study compares stages at which Lyme disease was diagnosed by race in a specialty clinic in the US.
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Affiliation(s)
- Samuel J. Starke
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison W. Rebman
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Miller
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ting Yang
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John N. Aucott
- Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Thompson AD, Balamuth F, Neville DN, Chapman LL, Levas MN, Kharbanda AB, Branda JA, Ladell MM, Loiselle C, Nigrovic LE. Sensitivity of Two-Tiered Lyme Disease Serology in Children With an Erythema Migrans Lesion. J Pediatric Infect Dis Soc 2023; 12:553-555. [PMID: 37756491 DOI: 10.1093/jpids/piad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023]
Abstract
In our prospective cohort of 192 children with a physician-diagnosed erythema migrans (EM) lesion, two-tier Lyme disease serology had higher sensitivity in children with multiple EM lesions (76.8% multiple lesions vs. 38.1% single EM; difference 38.7%, 95% confidence interval 24.8%-50.4%). The diagnosis of cutaneous Lyme disease should be based on careful physical examination rather than laboratory testing.
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Affiliation(s)
- Amy D Thompson
- Division of Emergency Medicine, Nemours Children's Hospital and Sidney Kimmel Medical College of Thomas Jefferson University, Wilmington, Delaware, USA
| | - Fran Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Desiree N Neville
- Division of Emergency Medicine, Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura L Chapman
- Division of Pediatric Emergency Medicine, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael N Levas
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Meagan M Ladell
- Department of Pediatric Emergency Medicine, Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Claire Loiselle
- Department of Research, Nemours Children's Hospital, Wilmington, Delaware, USA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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