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Volume 31, Number 9—September 2025
Research
Differences in Lyme Disease Diagnosis among Medicaid and Medicare Beneficiaries, United States, 2016–2021
L. Hannah Gould
, Sarah J. Willis, Christopher G. Prener, Stephanie A. Duench, Holly Yu, Luis Jodar, Jennifer C. Moïsi, and James H. Stark
, Sarah J. Willis, Christopher G. Prener, Stephanie A. Duench, Holly Yu, Luis Jodar, Jennifer C. Moïsi, and James H. Stark
Table 2
Clinical characteristics of cases among Medicaid beneficiaries in a study of differences in Lyme disease diagnosis among Medicaid and Medicare beneficiaries, United States, 2016–2021*
| Characteristic | Medicaid, age <18 y |
Medicaid, age >19 y |
|||||
|---|---|---|---|---|---|---|---|
| White, n = 29,405 | Non-White, n = 4,371 | PR (95% CI) or p value | White, n = 26,298 | Non-White, n = 4,637 | PR (95% CI) or p value | ||
| Disseminated disease† | 4,685 (15.9) | 1,234 (28.2) | 1.77 (1.68–1.87) | 4,542 (17.3) | 1,259 (27.2) | 1.57 (1.49–1.66) | |
| Neurologic | 1,248 (26.6) | 265 (21.5) | 0.00006 | 2,054 (45.2) | 518 (41.1) | 0.002 | |
| Musculoskeletal | 3,353 (71.6) | 941 (76.3) | NA | 2,299 (50.6) | 704 (55.9) | NA | |
| Cardiac |
84 (1.8) |
28 (2.3) |
NA |
189 (4.2) |
37 (2.9) |
NA |
|
| Hospitalization at diagnosis |
645 (2.2) |
188 (4.3) |
1.96 (1.67–2.30) |
1,124 (4.3) |
229 (4.9) |
1.56 (1.01–1.33) |
|
| Diagnosed outside of primary care‡ |
4,170 (17.7) |
644 (19.1) |
1.08 (0.99–1.18) |
4,893 (23.2) |
824 (23.1) |
0.99 (0.92–1.08) |
|
| Diagnosed during September–March |
6,271 (21.3) |
1,204 (27.5) |
1.29 (1.23–1.36) |
7,351 (28.0) |
1,596 (34.4) |
1.23 (1.18–1.29) |
|
| Sex | |||||||
| M | 16,227 (55.2) | 2,301 (52.6) | Referent | 12,067 (45.9) | 1627 (35.1) | Referent | |
| F |
13,178 (44.8) |
2,070 (47.4) |
1.06 (1.02–1.09) |
14,231 (54.1) |
3,010 (64.9) |
1.20 (1.17–1.23) |
|
| Mean Quan-Charlson Comorbidity Index score (SD) |
1.1 (0.3) |
1.1 (0.2) |
0.339 |
1.7 (1.3) |
1.8 (1.5) |
0.003 |
|
| Mean no. visits before diagnosis (SD) | |||||||
| <30 d before | 1.8 (2.5) | 2.0 (2.5) | <0.0001 | 2.7 (3.4) | 3.2 (3.6) | <0.0001 | |
| <60 d before | 3.2 (4.5) | 3.4 (4.4) | 0.006 | 4.9 (6.3) | 5.6 (6.6) | <0.0001 | |
| <183 d before |
8.8 (12.8) |
8.8 (12.3) |
0.8843 |
13.6 (17.6) |
14.3 (17.2) |
0.0122 |
|
| Treatment and testing | |||||||
| Amoxicillin | 16,989 (57.8) | 2,576 (58.9) | 1.02 (0.97–1.08) | 4,128 (15.7) | 894 (19.3) | 1.22 (1.13–1.32) | |
| Doxycycline | 12,708 (43.2) | 1,882 (43.1) | 1.00 (0.94–1.06) | 22,518 (85.6) | 3,841 (82.8) | 0.96 (0.92–1.00) | |
| Antibody testing§ | 4,141 (14.1) | 923 (21.1) | 1.08 (1.07–1.11) | 4,019 (15.3) | 1,025 (22.1) | 1.08 (1.07–1.11) | |
*Values are no. (%) except as indicated. Reference group = White. NA, not applicable; PR, prevalence ratio. †We used χ2 test to compare distribution of disseminated manifestations between White and non-White beneficiaries. ‡Calculated only among claims with known provider type. §Current Procedural Terminology code 86618, Borrelia burdorferi antibody.
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