Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010-2018

Abstract

We evaluated MarketScan, a large commercial insurance claims database, for its potential use as a stable and consistent source of information on Lyme disease diagnoses in the United States. The age, sex, and geographic composition of the enrolled population during 2010-2018 remained proportionally stable, despite fluctuations in the number of enrollees. Annual incidence of Lyme disease diagnoses per 100,000 enrollees ranged from 49 to 88, ≈6-8 times higher than that observed for cases reported through notifiable disease surveillance. Age and sex distributions among Lyme disease diagnoses in MarketScan were similar to those of cases reported through surveillance, but proportionally more diagnoses occurred outside of peak summer months, among female enrollees, and outside high-incidence states. Misdiagnoses, particularly in low-incidence states, may account for some of the observed epidemiologic differences. Commercial claims provide a stable data source to monitor trends in Lyme disease diagnoses, but certain important characteristics warrant further investigation.

Keywords: Borrelia; Lyme disease; United States; bacteria; incidence; public health surveillance; ticks; vector-borne infections; zoonoses.

Figure 1

Annual restricted and unrestricted MarketScan database enrollment population by year, United States, 2010–2018. The restricted MarketScan population was limited to enrollees with insurance coverage for an entire calendar year, with the potential for pharmaceutical claims data, and a primary beneficiary residing in the United States (excluding territories when possible).

Figure 2

Population composition comparison of MarketScan enrollees (A) and US population (B) by age group and sex, United States, 2010–2018.

Figure 3

Incidence of patients with Lyme disease diagnoses in MarketScan database versus cases found by surveillance, by sex, United States, 2010–2018. Incidence was calculated as diagnoses/100,000 enrollees in MarketScan or cases/100,000 population among each subcategory. Scales for the primary and secondary y axes differ substantially to underscore sex-related incidence patterns but do not permit direct comparison of the magnitude of Lyme disease incidence between systems.

Figure 4

Lyme disease incidence by age group and sex in MarketScan enrollees (A, C, E) and from surveillance (B, D, F) by geographic category of Lyme disease endemicity (A– B, high-incidence states; C–D, neighboring states; E–F, low-incidence states), United States, 2010–2018. Incidence was calculated as diagnoses/100,000 enrollees in MarketScan or cases/100,000 population among each subcategory. Scales for each y-axis differ substantially to underscore overall age-related incidence patterns but do not permit direct comparison of the magnitude of Lyme disease between systems or geographic categories.