Volume 29, Number 9—September 2023
Research
Validation of Claims-Based Algorithm for Lyme Disease, Massachusetts, USA
, Sheryl A. Kluberg, Sarah J. Willis, Susan Forrow, Bradford D. Gessner, Cameron T. Nutt, Alejandro Cane, Nathan Petrou, Meera Sury, Chanu Rhee, Luis Jodar, Aaron Mendelsohn, Emma R. Hoffman, Robert Jin, John Aucott, Sarah J. Pugh, and James H. Stark
Table 2
Demographic and clinical characteristics of Harvard Pilgrim Health Care members who met criteria for a validation study of a claims-based algorithm for Lyme disease during July 2000–June 2019 in Massachusetts, USA*
| Characteristics |
Total Lyme disease episodes |
Lyme disease episodes included in chart review |
|---|---|---|
| Total no. cases | 12,229 | 128 |
| Age groups, y | ||
| Pediatric, <18 | 3,494 (28.6) | 25 (19.5) |
| Adult, >18 | 8,735 (71.4) | 103 (80.5) |
| <1 | 8 (0.1) | 0 |
| 1–4 | 775 (6.3) | 8 (6.3) |
| 5–14 | 2,271 (18.6) | 16 (12.5) |
| 15–24 | 1,208 (9.9) | 7 (5.5) |
| 25–39 | 1,500 (12.3) | 16 (12.5) |
| 40–64 | 5,609 (45.9) | 62 (48.4) |
| >65 |
858 (7.0) |
19 (14.8) |
| Median age, y (IQR) |
42 (15–55) |
48 (29–60) |
| Sex | ||
| M | 6,675 (54.6) | 63 (49.2) |
| F |
5,554 (45.4) |
65 (50.8) |
| Antimicrobial drug | ||
| Doxycycline | 8,110 (66.3) | 107 (83.6) |
| Amoxicillin | 3,594 (29.4) | 18 (14.1) |
| Cefuroxime axetil | 341 (2.8) | 2 (1.6) |
| Azithromycin | 177 (1.5) | 1 (0.8) |
| Penicillin G |
7 (0.1) |
0 |
| Acute signs and symptoms† | ||
| No signs or symptoms | 6,931 (56.7) | 80 (62.5) |
| Joint pain | 1,681 (13.7) | 12 (9.4) |
| Rash‡ | 1,644 (13.4) | 20 (15.6) |
| Fatigue | 1,518 (12.4) | 10 (7.8) |
| Fever | 1,091 (8.9) | 6 (4.7) |
| Headache | 999 (8.2) | 7 (5.5) |
| Myalgia |
654 (5.3) |
10 (7.8) |
| Disseminated manifestations§ | ||
| Nervous system | 904 (7.4) | 9 (7.0) |
| Musculoskeletal | 326 (2.7) | 10 (7.8) |
| Ocular | 257 (2.1) | 3 (2.3) |
| Cardiovascular | 37 (0.3) | 0 |
*Values are no. (%) except as indicated. All data are from the Harvard Pilgrim Health Care administrative claims database. The 128 Lyme disease episodes included in the chart reviews were also included in the total Lyme disease episode data. IQR, interquartile range. †Rash, fever, chills, fatigue, headache, joint pain, neck pain or stiff neck, radiculopathy, myalgia, and paresthesia were derived from diagnosis codes from the International Classification of Diseases, 9th Revision, Clinical Modification, and International Classification of Diseases, 10th Revision, Clinical Modification, documented up to 14 d before or after the member met the claims-based definition of Lyme disease. ‡Upon medical record review, 62 of 128 (48.4%) cases had evidence of erythema migrans. §Nervous system, musculoskeletal, ocular, and cardiovascular manifestations were derived from diagnosis codes from the International Classification of Diseases, 9th Revision, Clinical Modification, and International Classification of Diseases, 10th Revision, Clinical Modification, documented up to 365 d after the member met the claims-based definition of Lyme disease. A patient can have both disseminated manifestations and acute signs and symptoms.