Triangulating the New Frontier of Health Geo-Data: Assessing Tick-Borne Disease Risk as an Occupational Hazard among Vulnerable Populations

Abstract

Determining interventions to combat disease often requires complex analyses of spatial-temporal data to improve health outcomes. For some vulnerable populations, obtaining sufficient data for related analyses is especially difficult, thus exacerbating related healthcare, research, and public health efforts. In the United States (U.S.), migrant and seasonal workers are especially affected in this regard, with data on health interventions and outcomes largely absent from official sources. In response, this study offers a multi-modal approach that involves triangulating geographically specified health data that incorporate reports on canine tick species, Lyme disease (LD) incidence, and patient symptom severity indicating potential subsequent disease burden. Spatial alignment of data at the U.S. county level was used to reveal and better understand tick-borne disease (TBD) incidence and risk among the identified populations. Survey data from migrant and seasonal workers in Texas were employed to determine TBD risk based on symptoms, occupations, and locations. Respondents who were found to have a higher likelihood of a TBD were also considerably more likely to report the most common symptoms of LD and other TBDs on the Horowitz Multiple Systemic Infectious Disease Syndrome Questionnaire. Those in the highly likely scoring group also reported more poor health and mental health days. Overall, a notable number of respondents (22%) were likely or highly likely to have a TBD, with particular relevance attributed to county of residence and living conditions. Also of note, almost a third of those reporting severe symptoms had received a previous Lyme disease diagnosis. These findings underscore the need for further surveillance among vulnerable populations at risk for TBDs.

Keywords: geo-data; migrant and seasonal workers; occupational hazards; tick-borne disease surveillance; triangulation; vulnerable populations.

Figure 1

Occupation by HMQ score.

Figure 2

Percent of respondents reporting top five symptoms indicative of a TBD “All the Time”.

Figure 3

Average poor mental health and health within the last 30 days by scoring category.

Figure 4

All survey respondent by counties and by counties with scores ≥ 21.

Figure 5

Percentage possible, likely, or highly likely, or not likely to have a TBD by county.

Figure 10

Canine ehrlichiosis, LD, and anaplasmosis by Texas counties (2021) [19].

Figure 6

Percent of canines testing positive by TBD in selected counties (2020) [19].

Figure 7

Human cases of LD, 2012–2018. County cases range from 0 to 179, with the darkest shades representing the counties with the highest number of cases. (Due to low case counts in some counties, data may not be provided to protect the identities of infected individuals).

Figure 8

Map of DSHS locally acquired and unknown ehrlichiosis, chaffeensis, 2008–2020, by respondents with most severe symptoms.

Figure 9

Map of DSHS locally acquired spotted fever rickettsiosis by respondents with most severe symptoms [22].

Figure 11

Selected human cases of TBDs in Texas from 2000 to 2019 [23].