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. 2018 May 30:361:k1998.
doi: 10.1136/bmj.k1998.

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

Niels Obel  1 , Ram B Dessau  2 , Karen A Krogfelt  3 , Jacob Bodilsen  4 , Nanna S Andersen  5 , Jens K Møller  6 , Casper Roed  7 , Lars H Omland  7 , Claus B Christiansen  8 , Svend Ellermann-Eriksen  9 , Jette M Bangsborg  10 , Klaus Hansen  11 , Thomas L Benfield  12 , Kenneth J Rothman  13   14 , Henrik T Sørensen  13 , Christian Ø Andersen  15 , Anne-Mette Lebech  7
Affiliations

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

Niels Obel et al. BMJ. .

Abstract

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than those listed above; KH has received royalties from Thermo Fisher; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Cumulative survival of 2067 Lyme neuroborreliosis (LNB) patients and 20 670 members of population comparison cohort
Fig 2
Fig 2
Cumulative incidence of haematological cancer among Lyme neuroborreliosis (LNB) patients and members of population comparison cohort
Fig 3
Fig 3
Proportion of people aged 20-60 years at study inclusion registered as receiving disability pension. Top: Lyme neuroborreliosis (LNB) patients and members of population comparison cohort. Bottom: family members of LNB patients and family members of population comparison cohort
Fig 4
Fig 4
Cumulative incidence of people aged <17 years at study inclusion graduating from high school. Top: Lyme neuroborreliosis (LNB) patients and members of population comparison cohort. Bottom: family members of LNB patients and family members of population comparison cohort
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