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. 2025 Aug 1;25(1):2603.
doi: 10.1186/s12889-025-23722-z.

Factors influencing Lyme borreliosis risk perception in Europe: a cross-sectional multi-country survey study

Emily Colby  1 , L Hannah Gould  2 , Ye Tan  3 , Andreas Pilz  4 , Gordon Brestrich  5 , Jennifer C Moisi  6 , James H Stark  7
Affiliations

Factors influencing Lyme borreliosis risk perception in Europe: a cross-sectional multi-country survey study

Emily Colby et al. BMC Public Health. .

Abstract

Background: Lyme borreliosis (LB) is the most common vector-borne disease in Europe. Research on factors that shape LB risk perception in Europe is limited. This study explores the potential drivers of LB risk perception in the general adult (18-65 years) population of twenty European countries, such as urbanicity, socioeconomic status, dog ownership, gender, age, and tick and LB diagnosis history.

Methods: Data were obtained from a 2022 survey of 28,034 adults aged 18-65 years in twenty European countries. The survey included questions on knowledge, attitudes, and practices related to ticks and LB. Respondents were categorized into three income levels (low, middle, or high) based on country-specific income tertiles. Descriptive statistics were calculated, and differences in responses to survey items by income level were assessed using chi-square tests. Risk perception was measured from a survey question asking respondents to rate their risk of contracting LB on a five-point scale from "very low risk" to "very high risk." Ordinal logistic regression modeled the relationship between predictor variables and LB risk perception.

Results: Having a past LB diagnosis (adjusted odds ratio [AOR]: 3.96, 95% confidence interval [CI]: 3.38-4.64) was most strongly tied to increased LB risk perception. Knowing someone with a past LB diagnosis or having a past tick bite, were also significantly associated with higher risk perception (AOR: 2.11, 95% CI: 1.97-2.27, and AOR: 1.71, 95% CI: 1.60-1.84, respectively). High-income respondents were most likely to report a past tick bite (55.4%, 95% CI: 53.5-57.3%) and a past LB diagnosis (13.5%, 95% CI: 12.1-14.8%).

Conclusions: Experience with ticks and LB (i.e., via bites or diagnoses) may play a key role in shaping LB risk perception among European adults. Dog ownership and demographic factors such as gender and age may also influence LB risk perception. These results could help LB educational campaigns addressing knowledge and perception gaps.

Keywords: Europe; Lyme borreliosis; Risk perception; Survey research; Ticks.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The survey was determined exempt from institutional review board oversight by the study investigators in accordance with categories of exempt research under 45 CFR part 46.104, Exempt Research [20]. All research was compliant with the principles laid out in the Helsinki Declaration [21]. Participation in the survey questions was preceded by a notice of the voluntariness of the survey, the respondent’s right to withdraw at any point, an agreement about a provision of health data, and a notice of privacy policies. Respondents were asked to check boxes to confirm their understanding and agreement before proceeding to the survey questions. Consent for publication: Not applicable. Competing interests: All authors are employees of Pfizer and may hold stock or stock options.

Figures

Fig. 1
Fig. 1
Lyme borreliosis (LB) weighted sample sizes and survey respondent risk perception scores by country (the width of the bar represents the weighted percentage of respondents in a given risk perception category); results are weighted by country subregion, gender, and age
Fig. 2
Fig. 2
Likert scale plot of Lyme borreliosis risk perception scores from respondents in a multi-country survey from twenty countries in Europe, 2022, results are shown with and without stratifications by urbanicity and income level; proportions have been weighted by country subregion, gender, and age
See this image and copyright information in PMC

References

    1. Lindren E, Jaenson T. Lyme borreliosis in Europe: Influences of Climate and Climate Change, Epidemiology, Ecology and Adaptation Measures. Geneva: World Health Organization; 2006.
    1. Burn L, et al. Incidence of Lyme borreliosis in Europe from National surveillance systems (2005–2020). Vector Borne Zoonotic Dis. 2023;23(4):156–71. - PMC - PubMed
    1. Vandekerckhove O, De Buck E, Van Wijngaerden E. Lyme disease in Western europe: an emerging problem? A systematic review. Acta Clin Belg. 2021;76(3):244–52. - PubMed
    1. Nagarajan A, et al. The landscape of Lyme borreliosis surveillance in Europe. Vector Borne Zoonotic Dis. 2023;23(4):142–55. - PMC - PubMed
    1. Diuk-Wasser MA, VanAcker MC, Fernandez MP. Impact of land use changes and habitat fragmentation on the Eco-epidemiology of Tick-Borne diseases. J Med Entomol. 2021;58(4):1546–64. - PubMed

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