Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

TY - JOUR

T1 - Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis

T2 - nationwide population based cohort study

AU - Obel, Niels

AU - Dessau, Ram B

AU - Krogfelt, Karen A

AU - Bodilsen, Jacob

AU - Andersen, Nanna S

AU - Møller, Jens K

AU - Roed, Casper

AU - Omland, Lars H

AU - Christiansen, Claus B

AU - Ellermann-Eriksen, Svend

AU - Bangsborg, Jette M

AU - Hansen, Klaus

AU - Benfield, Thomas L

AU - Rothman, Kenneth J

AU - Sørensen, Henrik T

AU - Andersen, Christian Ø

AU - Lebech, Anne-Mette

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PY - 2018

Y1 - 2018

N2 - OBJECTIVE: To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population.DESIGN: Nationwide population based cohort study using national registers.SETTING: Denmark.PARTICIPANTS: All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670).MAIN OUTCOME MEASURES: Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes.RESULTS: Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%).CONCLUSION: A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.

AB - OBJECTIVE: To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population.DESIGN: Nationwide population based cohort study using national registers.SETTING: Denmark.PARTICIPANTS: All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670).MAIN OUTCOME MEASURES: Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes.RESULTS: Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%).CONCLUSION: A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.

KW - Adolescent

KW - Adult

KW - Child

KW - Cognitive Dysfunction/epidemiology

KW - Denmark/epidemiology

KW - Disabled Persons/psychology

KW - Educational Status

KW - Employment/statistics & numerical data

KW - Female

KW - Humans

KW - Interpersonal Relations

KW - Lyme Neuroborreliosis/complications

KW - Male

KW - Middle Aged

KW - Sentinel Surveillance

KW - Survivors/psychology

KW - Young Adult

U2 - 10.1136/bmj.k1998

DO - 10.1136/bmj.k1998

M3 - Journal article

C2 - 29848547

SN - 0959-8146

VL - 361

JO - The BMJ

JF - The BMJ

M1 - k1998

ER -