Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

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  • Niels Obel, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark niels.obel@regionh.dk.
  • ,
  • Ram B Dessau, Department of Clinical Microbiology , Slagelse Hospital, Slagelse Denmark
  • ,
  • Karen A Krogfelt, Bacteria, Parasites and Fungi Department, Statens Serum Institute, Copenhagen, Denmark.
  • ,
  • Jacob Bodilsen, Department of Clinical Microbiology and Infectious Diseases, Aalborg University hospital, Aalborg, Denmark.
  • ,
  • Nanna S Andersen
  • Jens K Møller, Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
  • ,
  • Casper Roed, University of Copenhagen
  • ,
  • Lars H Omland, University of Copenhagen
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  • Claus B Christiansen, University of Copenhagen
  • ,
  • Svend Ellermann-Eriksen
  • Jette M Bangsborg, Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: bente.ruth.scharvik.olesen@regionh.dk.
  • ,
  • Klaus Hansen, Department of Neurology, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
  • ,
  • Thomas L Benfield, University of Copenhagen
  • ,
  • Kenneth J Rothman, Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
  • ,
  • Henrik T Sørensen
  • Christian Ø Andersen, e Department of Clinical Microbiology , Copenhagen University Hospital , Hvidovre , Denmark.
  • ,
  • Anne-Mette Lebech, University of Copenhagen

OBJECTIVE: To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population.

DESIGN: Nationwide population based cohort study using national registers.

SETTING: Denmark.

PARTICIPANTS: All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670).

MAIN OUTCOME MEASURES: Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes.

RESULTS: Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%).

CONCLUSION: A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.

Original languageEnglish
Article numberk1998
JournalB M J
Volume361
Number of pages9
ISSN0959-8146
DOIs
Publication statusPublished - 30 May 2018

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