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The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013–2016): an ecological study
  1. John S P Tulloch1,2,
  2. Amanda E Semper3,4,
  3. Tim J G Brooks3,4,
  4. Katherine Russell5,
  5. Kate D Halsby5,
  6. Robert M Christley1,6,
  7. Alan D Radford1,6,
  8. Roberto Vivancos2,7,
  9. Jenny C Warner3,4
  1. 1 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
  2. 2 Field Epidemiology Service, Public Health England, Liverpool, UK
  3. 3 Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
  4. 4 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
  5. 5 National Infection Service, Public Health England, London, UK
  6. 6 Institute of Infection and Global Health, University of Liverpool, Neston, UK
  7. 7 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, UK
  1. Correspondence to Dr John S P Tulloch; jtulloch{at}


Objective Lyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory.

Design An ecological study of routinely collected laboratory surveillance data.

Setting Public Health England’s national Lyme disease testing laboratory.

Participants 3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016.

Results In England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6–10 and 61–65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient’s resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution.

Conclusions These results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.

  • Lyme disease
  • lyme borreliosis
  • epidemiology
  • England
  • surveillance
  • laboratory

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  • Contributors JSPT, RMC, RV, ADR and JCW contributed to the design and implementation of the research. AES, TJGB, KR, KDH and JCW provided the Rare and Imported Pathogens Laboratory data set and assisted in its cleaning. JSPT performed data analysis. JSPT and JCW wrote the manuscript in consultation with KR, KDH, RMC, RV, ADR, TJGB and AES.

  • Funding The research was funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE) and in collaboration with Liverpool School of Tropical Medicine. JSPT, RMC and ADR are based at the University of Liverpool. TJGB, AES and JCW are based at the PHE Rare and Imported Pathogens Laboratory, Porton Down. RV is based at PHE, Liverpool. KR and KDH are based in the Emerging Infection and Zoonoses section at PHE. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR and the Department of Health or Public Health England.

  • Competing interests None declared.

  • Ethics approval No ethical approval was required as these anonymised patient data were collected for public health surveillance under The Health Protection Legislation (England) Guidance 2010.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used in this research are not made publicly available.

  • Patient consent for publication Not required.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

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