Spatio-temporal patterns in county-level incidence and reporting of Lyme disease in the northeastern United States, 1990–2000

摘要

We present an exploratory analysis of reported county-specific incidence of Lyme disease in the northeastern United States for the years 1990–2000. We briefly review the disease ecology of Lyme disease and the use of risk maps to describe local incidence as estimates of local risk of disease. We place the relevant elements of local environmental and ecological variables, local disease incidence, and (importantly) local disease reporting in a conceptual context to frame our analysis. We then apply hierarchical linear models of increasing complexity to summarize observed patterns in reported incidence, borrowing information across counties to improve local precision. We find areas of increasing incidence in the central northeastern Atlantic coast counties, increasing incidence branching to the north and west, and an area of fairly stable and slightly decreasing reported incidence in western New York.