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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 GouldComments to Author , Sarah J. Willis, Christopher G. Prener, Stephanie A. Duench, Holly Yu, Luis Jodar, Jennifer C. Moïsi, and James H. Stark
Author affiliation: Global Vaccines Medical Affairs, Pfizer, Inc., New York, New York, USA (L.H. Gould); Global Vaccines Medical Affairs, Pfizer, Inc., Cambridge, Massachusetts, USA (S.J. Willis, J.H. Stark); RWE Platforms and Partnerships, Pfizer, Inc., New York (C.G. Prener); US Medical Affairs, Vaccines and Anti-infectives, Pfizer, Inc., Collegeville, Pennsylvania, USA (S.A. Duench); Global HTA, Value & Evidence Vaccines, Pfizer, Inc., Collegeville (H. Yu); Global Vaccines Medical Affairs, Pfizer, Inc., Collegeville (L. Jodar); Global Vaccines Medical Affairs, Inc., Pfizer, Paris, France (J.C. Moïsi)

Main Article

Table 3

Clinical characteristics of cases among Medicare beneficiaries in a study of differences in Lyme disease diagnosis among Medicaid and Medicare beneficiaries, United States, 2016–2021*

Characteristic Medicare, age <65 y
 Medicare, age >65 y
White, n = 11,845 Non-White, n = 1,066 PR (95% CI) or p value White, n = 87,831 Non-White, n = 3,037 PR (95% CI) or p value
Disseminated disease† 3,345 (28.2) 400 (37.5) 1.33 (1.22–1.44) 18,277 (20.8) 817 (26.9) 1.29 (1.22–1.37)
Neurologic 2,155 (64.4) 242 (60.5) NA 9,808 (53.7) 428 (52.4) 0.055
Musculoskeletal 1,101 (32.9) – NA 7,127 (39.0) 344 (42.1) NA
Cardiac
89 (2.7)
 –
 NA
1,342 (7.3)
 45 (5.5)
 NA
Hospitalization at diagnosis
 967 (8.2)
 109 (10.2)
 1.25 (1.04–1.51)
6,325 (7.2)
 250 (8.2)
 1.14 (1.01–1.29)
Diagnosed outside of primary care‡
 4,105 (36.4)
 447 (44.3)
 1.22 (1.08–1.37)
27,719 (32.6)
 1,275 (43.6)
 1.34 (1.25–1.43)
Diagnosed during September–March
 3,793 (32.0)
 377 (35.4)
 1.10 (1.01–1.20)
22,316 (25.4)
 890 (29.3)
 1.15 (1.09–1.22)
Sex
M 5,199 (43.9) 400 (37.5) Referent 41,438 (47.2) 1,322 (43.5) Referent
F
 6,646 (56.1)
 666 (62.5)
 1.11 (1.06–1.17)
46,393 (52.8)
 1,715 (56.5)
 1.07 (1.04–1.10)
Mean Quan-Charlson Comorbidity Index score (SD)
 2.4 (2.0)
 2.9 (2.3)
 <0.0001
2.6 (2)
 2.8 (2.2)
 <0.0001
Mean no. visits before diagnosis (SD)
<30 d before 0.99 (1.5) 1.1 (1.6) 0.111 0.7 (1.2) 0.6 (1.1) <0.0001
<60 d before 1.8 (2.5) 1.9 (2.7) 0.057 1.2 (1.9) 1.0 (1.7) <0.0001
<183 d before
 4.8 (6.2)
 5.2 (6.6)
 0.448
3.1 (4.4)
 2.6 (4.1)
 <0.0001
Treatment and testing
Amoxicillin 2,297 (19.4) 295 (27.7) 1.43 (1.25–1.64) 13,594 (15.5) 632 (20.8) 1.32 (1.21–1.44)
Doxycycline 9,208 (77.7) 758 (71.1) 0.92 (0.83–1.01) 73,558 (83.7) 2,366 (77.9) 0.92 (0.87–0.97)
Antibody testing§ 5,619 (47.4) 522 (49.0) 1.03 (0.97–1.09) 42,212 (48.1) 1,617 (53.2) 1.10 (1.06–1.13)

*Values are no. (%) except as indicated. Reference group = White. NA, not applicable; PR, prevalence ratio; –, sample size <11, thus counts suppressed from calculations. †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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Page created: July 09, 2025
Page updated: August 18, 2025
Page reviewed: August 18, 2025
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