Background: Longer time between symptom onset and treatment of
Lyme disease has been associated with poor outcomes. Reducing
time-to-treatment requires knowledge of risks for
treatment delays. We conducted a population-based study to evaluate factors associated with
delayed treatment of
Lyme disease and the relation between
delayed treatment and
post-treatment Lyme disease syndrome (PTLDS). Methods: We mailed questionnaires to 5,314 individuals with a
Lyme disease diagnosis or blood test followed by an
antibiotic order in the medical record of a Pennsylvania health system from 2015 to 2017. Analyses were confined to 778 respondents who reported that they were treated for
Lyme disease within the past 5 years and reported a
rash and/or a positive blood test for
Lyme disease.
Time-to-treatment was calculated as the sum of two windows before and after seeking care for
Lyme disease symptoms: time to first medical contact and time under care. We used logistic regression to evaluate factors associated with delayed
time-to-treatment in each time window (>14 days vs. ≤14 days) and the association between total
time-to-treatment (>30 days vs. ≤30 days) and PTLDS. We used inverse probability weighting to calculate estimates for the study's source population (5,314 individuals sent questionnaires). Results: In the source population, 25% had time to first contact >14 days, 21% had time under care >14 days, and 31% had a total
time-to-treatment >30 days. Being uninsured and attributing initial symptoms to something other than
Lyme disease were positively associated with delayed time to first medical contact, while seeking care at an
urgent care or emergency setting (vs. primary care) was negatively associated. Diagnoses between November and April, and the absence of
rash were positively associated with delays. Individuals whose treatment was delayed, defined as
time-to treatment >30 days had 2.26 (95% confidence interval: 1.25, 4.05) times the odds of PTLDS as those who were treated within 30 days of symptom onset. Conclusions: In a population-based study in Pennsylvania, one-third of
Lyme disease patients reported
delayed treatment, which was associated with PTLDS. To improve
Lyme disease outcomes, prevention efforts should aim to reduce the time before and after seeking care.