TY - JOUR
T1 - Healthcare-seeking behaviour preceding diagnosis of Lyme neuroborreliosis
T2 - population-based nationwide matched nested case-control study
AU - Tetens, Malte M
AU - Omland, Lars Haukali
AU - Andersen, Nanna S
AU - Bangsborg, Jette
AU - Bodilsen, Jacob
AU - Dessau, Ram B
AU - Ellermann-Eriksen, Svend
AU - Jørgensen, Charlotte Sværke
AU - Møller, Jens Kjølseth
AU - Yde Nielsen, Alex Christian
AU - Pedersen, Michael
AU - Søgaard, Kirstine K
AU - Obel, Niels
AU - Lebech, Anne-Mette
N1 - Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PY - 2024/7/9
Y1 - 2024/7/9
N2 - Objectives: To identify diagnostic opportunities, we investigated healthcare-seeking behaviour among patients with Lyme neuroborreliosis (LNB) within 28 weeks before diagnosis. Methods: We conducted a population-based, nationwide matched nested case-control study (Denmark, 2009–2021). As cases, we included all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis). We randomly selected controls from the general population and matched 10:1 on date of birth and sex. Exposures were assignment of diagnostic codes for symptoms, contact to medical specialties, medical wandering, and undergoing diagnostic procedures. We calculated the weekly and 3-month proportions of individuals with exposures and calculated absolute risk differences with corresponding 95% CI. Results: We included 1056 cases with LNB and 10 560 controls. Within 3 months before diagnosis, the most frequent assigned symptoms were pain (difference: 13.0%, 95% CI: 10.9–15.1). Cases with LNB exhibited increased contact with most specialties, particularly general practitioners (difference: 48.7%, 95% CI: 46.0–51.4), neurology (difference: 14.3%, 95% CI: 11.7–16.8), and internal medicine (difference: 11.1%, 95% CI: 8.7–13.5), and medical wandering (difference: 17.1%, 95% CI: 14.3–20.0). Common diagnostic procedures included imaging of the brain (difference: 10.2, 95% CI: 8.3–12.1), the spine (difference: 8.8%, 85% CI: 7.0–10.6), and the abdomen (difference: 7.2%, 95% CI: 5.4–9.1). The increase in healthcare-seeking behaviour was observed ≤12 weeks preceding diagnosis. Discussion: Pain appears to be an ambiguous symptom of LNB, potentially contributing to delays in establishing the correct diagnosis. It would be difficult to identify patients with LNB more effectively as the increased healthcare-seeking behaviour preceding diagnosis is distributed across many medical specialties.
AB - Objectives: To identify diagnostic opportunities, we investigated healthcare-seeking behaviour among patients with Lyme neuroborreliosis (LNB) within 28 weeks before diagnosis. Methods: We conducted a population-based, nationwide matched nested case-control study (Denmark, 2009–2021). As cases, we included all Danish residents with LNB (positive Borrelia burgdorferi intrathecal antibody index test and cerebrospinal fluid pleocytosis). We randomly selected controls from the general population and matched 10:1 on date of birth and sex. Exposures were assignment of diagnostic codes for symptoms, contact to medical specialties, medical wandering, and undergoing diagnostic procedures. We calculated the weekly and 3-month proportions of individuals with exposures and calculated absolute risk differences with corresponding 95% CI. Results: We included 1056 cases with LNB and 10 560 controls. Within 3 months before diagnosis, the most frequent assigned symptoms were pain (difference: 13.0%, 95% CI: 10.9–15.1). Cases with LNB exhibited increased contact with most specialties, particularly general practitioners (difference: 48.7%, 95% CI: 46.0–51.4), neurology (difference: 14.3%, 95% CI: 11.7–16.8), and internal medicine (difference: 11.1%, 95% CI: 8.7–13.5), and medical wandering (difference: 17.1%, 95% CI: 14.3–20.0). Common diagnostic procedures included imaging of the brain (difference: 10.2, 95% CI: 8.3–12.1), the spine (difference: 8.8%, 85% CI: 7.0–10.6), and the abdomen (difference: 7.2%, 95% CI: 5.4–9.1). The increase in healthcare-seeking behaviour was observed ≤12 weeks preceding diagnosis. Discussion: Pain appears to be an ambiguous symptom of LNB, potentially contributing to delays in establishing the correct diagnosis. It would be difficult to identify patients with LNB more effectively as the increased healthcare-seeking behaviour preceding diagnosis is distributed across many medical specialties.
KW - Neuroborreliosis
KW - clinical epidemiology
KW - Borrelia burgdorferi sensu lato
KW - Case-control studies
KW - Epidemiology
KW - Healthcare utilization
KW - Lyme neuroborreliosis
KW - Registry-based
KW - Treatment delay
U2 - 10.1016/j.cmi.2024.07.004
DO - 10.1016/j.cmi.2024.07.004
M3 - Journal article
C2 - 38992431
SN - 1198-743X
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
ER -