EMERGENCE OF LYME-DISEASE IN HUNTERDON COUNTY, NEW-JERSEY, 1993 - A CASE-CONTROL STUDY OF RISK-FACTORS AND EVALUATION OF REPORTING PATTERNS

Reported cases of Lyme disease in Hunterdon County, New Jersey, increa sed almost 200% from 75 (67/100,000 population) in 1992 to 216 (193/10 0,000 population) in 1993, For evaluation of risk factors for Lyme dis ease and for determination of the cause of this increase, a case-contr ol study was conducted, and the reporting practices of physicians' off ices were evaluated, For cases reported in 1993, age and sex distribut ion, month of disease onset, and proportion of cases with erythema mig rans rash were within expected limits. Analysis of age-matched case-co ntrol data showed that rural residence; clearing periresidential brush during spring and summer months; and the presence of rock walls, wood s, deer, or a bird feeder on residential property were associated with incident Lyme disease, A review of physician reporting patterns sugge sted that the increase in reported cases in 1993 was due to improved r eporting as well as to an increase in the numbers of patients diagnose d with Lyme disease, In addition, substantial underreporting of Lyme d isease by physicians' offices was found.