Incidence and management of Lyme disease: a Scottish general practice retrospective study

Abstract

Background: The true burden of Lyme disease in primary care in Scotland is unknown. Epidemiological data are currently based on laboratory-confirmed reports as there is no mandatory reporting of clinical cases.

Aim: To analyse data from general practice in NHS Highland (North) over a 6-year period to assess the incidence and management of Lyme disease in primary care.

Design & setting: This was a retrospective descriptive study. Study data from 2017 to 2022 were extracted from all 63 general practices within NHS Highland (North).

Method: Consultations for Lyme disease were identified via Lyme-related clinical Read codes, requests for borrelia tests , free text, 'tags' and/or Lyme disease antibiotic scripts.

Results: Using Read codes to identify patients with Lyme disease or suspected Lyme disease gave an estimated average annual incidence of 124/100 000 population, which was 2.1 times more than estimates based solely on laboratory-confirmed reports. The incidence figures increased 5.2 times (362/100 000 population) when patients with Lyme disease or suspected Lyme disease (identified via Read codes, laboratory test requests, and free text tags) who were given antibiotic treatment were taken into account. Local 'hot spots' of infection were identified. Analysis of the antibiotic data indicates that antibiotic prescribing in NHS Highland largely follows the National Institute for Health and Care Excellence (NICE) guidelines.

Conclusion: This data analysis pathway can, and should, be rolled out across the whole of Scotland to assess the incidence and management of Lyme disease in primary care and allow appropriate allocation of resources.

Keywords: Lyme disease; general practice; incidence.

Figure 1.. Age distribution of patients treated for Lyme disease, identified by Lyme Read code, borrelia test request, or text tag (2019-2022,n = 3412). Antibiotic data not available for 2017 and 2018.

Figure 2.. Number of patients treated for Lyme disease (cases) and average annual incidence per 10 000 practice population for general practices within NHS Highland (North)(2019–2022). Antibiotic data not available for 2017 and 2018.