"Borrelioosin (borrelia-bakteerin) tiedetään aiheuttavan kuolemantapauksia, mutta tapausten määrästä on eriäviä mielipiteitä. Kansainvälisen Borrelioosijärjestön, ILADSin, puheenjohtajan Tri Bransfieldin mukaan määrä on todennäköisesti merkittävä. Tapauksia ei vain todeta sillä bakteeri aiheuttaa lukuisia oireita kuten ALS, MS, dementia jne.
Kuolemansyyselvityksissä ei yleensä selvitetä borrelia-bakteerin osuutta kuolemiin. Niissä todetaan sairauden nimi eli oire eikä syytä oireisiin. Siksi on väärin todeta kuolemantapausten olevan harvinaisia. Esim. Borrelioosia sairastavien suurempi riski tehdä itsemurhia on yksi merkittävä syy kuolemantapauksiin."
http://www.reuters.com/article/idUSTRE7 ... geNumber=1
Lyme disease a rare cause of death: study
Thu, Jan 6 2011
By Amy Norton
NEW YORK (Reuters Health) - While controversy still brews over the long-term effects of Lyme disease, a new government study concludes that the tick-borne illness is rarely a cause of death in the U.S.
Using death records collected from 45 U.S. states, researchers at the Centers for Disease Control and Prevention (CDC) found that between 1999 and 2003, there were 114 records listing Lyme disease as a cause of death.
But in most cases, Lyme disease was listed as one of multiple health problems contributing to a person's death, and only 23 records showed the disease as the underlying cause.
Of those, the investigators say, just one was consistent with known "clinical manifestations" of Lyme disease. In that case, the person died of respiratory failure that the death record tied to long-term effects on the central nervous system.
The findings, the CDC researchers say, indicate that Lyme disease "is rare as a cause of death in the U.S."
But that conclusion is unlikely to settle the broader controversy surrounding the long-term effects of Lyme disease in some people -- which, some doctors and patient groups say, do include serious and sometimes fatal health problems.
Lyme disease is a bacterial infection transmitted by certain ticks. The initial symptom is most often a gradually spreading "bull's eye" rash at the site of the tick bite.
Other early symptoms include fever, fatigue, headache and muscle and joint aches. Without early treatment, the infection can sometimes spread within days to weeks to different parts of the body -- causing symptoms like neck stiffness, shooting pains from nerve damage, heartbeat irregularities and a loss of muscle tone in the face called Bell's palsy.
The CDC and major medical groups say most cases of Lyme disease can be cured within about four weeks of oral antibiotics.
Some people do develop lasting problems after infection, sometimes even with antibiotic treatment.
According to the CDC, up to five percent of untreated people have chronic neurological complaints like shooting pain or numbness, or memory and concentration problems, months to years later. And a "small percentage" of those treated with antibiotics report symptoms that last for months to years, including arthritis pain, memory problems and fatigue.
But exactly what is causing those problems is unclear.
Then there are the people who are diagnosed with "chronic" Lyme disease based on non-specific symptoms -- like chronic pain and severe fatigue -- despite having no evidence of a current or past infection with the Lyme-causing bacteria.
This diagnosis is highly controversial because such people could have any of a number of other health problems, like depression or fibromyalgia, and their symptoms are common in the general population.
As for the lethality of Lyme disease, it is plausible that certain documented long-term effects of Lyme disease could contribute to some deaths, according to Dr. Kevin S. Griffith of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
"But the reality is that (Lyme disease) has only rarely been reported to lead to death," Griffith said in an interview. And based on this study, he noted, even death records that do list Lyme disease as a cause often don't stand up to scrutiny.
But Dr. Robert Bransfield, president of the non-profit International Lyme and Associated Diseases Society, took issue with the CDC study methods -- including its reliance on what doctors list on death records.
"There was no attempt to identify deaths from Lyme disease that may have been identified as a death from some other illness," said Bransfield, whose controversial group contends that chronic Lyme disease is a growing problem, and that many people with the infection need longer courses of antibiotics to help prevent it.
"You can't generalize from this to say that deaths from Lyme disease are rare," he said.
Exactly how many deaths might be attributable to Lyme disease is unclear, according to Bransfield. But he argued that the number could be "significant," if the question were looked at in a broader way.
Bransfield, a psychiatrist, said that suicide may be the major way that Lyme disease can prove fatal. He acknowledged, though, that this belief is based on anecdotal evidence, and there is a lack of hard statistics on Lyme disease and suicide risk.
Bransfield also noted that some researchers have speculated that the infection can ultimately contribute to cases of dementia, multiple sclerosis and amyotrophic lateral sclerosis
(ALS).
There is, however, no proof of that in the scientific literature, Griffith said.
The CDC report, Griffith stressed, is not intended to be "dismissive."
"We encourage clinicians to report on any patient that they suspect has died due to Lyme disease," he said.
He added that it's important to get that information out to the medical community so that the evidence can be evaluated.
"While anecdotes are compelling, scientific progress must be based on evidence," he said.
SOURCE: bit.ly/f5vLS2 Clinical Infectious Diseases, online December 28, 2010.
"But the reality is that (Lyme disease) has only rarely been reported to lead to death," Griffith said in an interview. And based on this study, he noted, even death records that do list Lyme disease as a cause often don't stand up to scrutiny.
But Dr. Robert Bransfield, president of the non-profit International Lyme and Associated Diseases Society, took issue with the CDC study methods -- including its reliance on what doctors list on death records.
"There was no attempt to identify deaths from Lyme disease that may have been identified as a death from some other illness," said Bransfield, whose controversial group contends that chronic Lyme disease is a growing problem, and that many people with the infection need longer courses of antibiotics to help prevent it.
"You can't generalize from this to say that deaths from Lyme disease are rare," he said.
Exactly how many deaths might be attributable to Lyme disease is unclear, according to Bransfield. But he argued that the number could be "significant," if the question were looked at in a broader way.
Bransfield, a psychiatrist, said that suicide may be the major way that Lyme disease can prove fatal. He acknowledged, though, that this belief is based on anecdotal evidence, and there is a lack of hard statistics on Lyme disease and suicide risk.
Bransfield also noted that some researchers have speculated that the infection can ultimately contribute to cases of dementia, multiple sclerosis and amyotrophic lateral sclerosis
(ALS).
There is, however, no proof of that in the scientific literature, Griffith said.
The CDC report, Griffith stressed, is not intended to be "dismissive."
"We encourage clinicians to report on any patient that they suspect has died due to Lyme disease," he said.
He added that it's important to get that information out to the medical community so that the evidence can be evaluated.
"While anecdotes are compelling, scientific progress must be based on evidence," he said.
SOURCE: bit.ly/f5vLS2 Clinical Infectious Diseases, online December 28, 2010.
Borrelioosi/kuolemantapausten määrä?
Valvojat: Jatta1001, Borrelioosiyhdistys, Bb
Tutkimus johon artikkelissa viitataan:
A Review of Death Certificates Listing Lyme Disease as a Cause of Death in the United States
1. Kiersten J. Kugeler1,
2. Kevin S. Griffith1,
3. L. Hannah Gould1,
4. Ken Kochanek2,
5. Mark J. Delorey1,
6. Brad J. Biggerstaff1, and
7. Paul S. Mead1
+ Author Affiliations
1.
1Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, and the location is Fort Collins, CO, USA
2.
2Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, USA
1. Correspondence: Kevin S. Griffith, MD, MPH, 3150 Rampart Road, Fort Collins, CO 80521 (kkg8@cdc.gov).
Next Section
Abstract
Lyme disease was listed as an underlying or multiple cause of death on 114 death records during 1999?2003. Upon review, only 1 record was consistent with clinical manifestations of Lyme disease. This analysis indicates that Lyme disease is rare as a cause of death in the United States.
Lyme disease is a tickborne disease caused by Borrelia burgdorferi. In the United States, cases most commonly occur among persons aged 5?14 years and 45?54 years, and during the summer months in the northeastern, mid-Atlantic, and north-central states [1]. Clinically, early Lyme disease is characterized by fever, fatigue, headache, arthralgias, myalgias, and erythema migrans rash. Untreated, the infection may disseminate to cause various manifestations, including secondary skin lesions, cranial neuropathy, lymphocytic meningitis, radiculoneuritis, atrioventricular block, and oligoarthritis [2]. However, Lyme disease rarely has been reported as a cause of death in the United States [3?6].
The International Classification of Diseases (ICD) is the international standard for categorizing health and vital records, including death certificates. When the ICD was updated to version 10, which became effective in the United States in 1999, Lyme disease was given a unique code and thus could be captured as a cause of death on death certificates. During 1999?2003, the Morbidity and Mortality Weekly Report (MMWR) Summary of Notifiable Diseases listed 24 deaths (median per year, 5; range per year, 2?7) attributed to Lyme disease (available at http://www.cdc.gov/mmwr/mmwr_nd/index.html). To describe the epidemiology of deaths attributed to Lyme disease, we reviewed death records and death certificates in the United States during 1999?2003.
Previous SectionNext Section
METHODS
Death records from 1999 to 2003 for which Lyme disease was coded as an underlying or multiple cause of death were requested from the National Center for Health Statistics (NCHS). The underlying cause of death is defined as ?the disease or injury which initiated the chain of morbid events leading directly to death? [7]. A multiple cause of death is defined as ?any other significant condition which contributed to the fatal outcome, but was not related to the disease or condition directly causing death? [7]. Part I of a death certificate contains the causal sequence from the underlying cause to the terminal event, and Part II contains any other significant medical conditions that contributed, but were not directly related, to the causal sequence. Death certificates were coded according to the ICD-10 in state vital records departments using a computerized algorithm updated annually by NCHS. All records with ICD-10 codes assigned to Lyme disease (ie, A69.2 and L90.4) were requested. Data obtained included month and year of death, age, sex, state of residence, state of death, and ICD-10 codes for underlying and multiple causes of death. Copies of corresponding death certificates were requested from states and reviewed. Analyses were conducted using Microsoft Excel and SAS software, version 9.1. Death record analysis was exempt from human subjects review at CDC, but approval was obtained from states when required. Plausibility of association with Lyme disease was based on well-established clinical manifestations of Lyme disease published in the peer-reviewed literature.
Previous SectionNext Section
RESULTS
Approval to release death records during the study period was received from all states except Idaho, Iowa, Louisiana, Maine, and Tennessee. Among the 45 remaining states, Lyme disease was coded as an underlying or multiple cause of death for 119 records from 25 states. When requesting corresponding death certificates, one certificate could not be located by the state, one was never requested in error, two certificates did not contain a diagnosis or any wording of Lyme disease or B. burgdorferi infection, and one certificate was destroyed and the corresponding data deleted during our analysis due to expiration of the state's human subjects approval per state guidelines. Analyses were conducted on the remaining 114 death certificates.
The median age of decedents was 71 years (range: 19?99 years); 66 (58%) were male. The relative age-group specific rates of persons with Lyme disease listed as an underlying or multiple cause of death, all-cause mortality in the United States and incident cases of Lyme disease are shown in Figure 1. Deaths were evenly distributed throughout the study period (1999: n = 25; 2000: n = 23; 2001: n = 14; 2002: n = 25; 2003: n = 27) and across seasons. Deaths were reported among residents of Connecticut (19), Pennsylvania (18), New Jersey (13), New York (12), California (8), Massachusetts (5), Minnesota (5), Wisconsin (5), Virginia (4), Florida (3), Missouri (3), Texas (3), Maryland (2), Michigan (2), West Virginia (2), Alabama (1), Arkansas (1), Colorado (1), Iowa (1) (The death record and certificate for this decedent were from Kansas, but Iowa was listed as the state of residence.), Illinois (1), Indiana (1), North Carolina (1), North Dakota (1), South Carolina (1), and Washington (1).
Figure 1.
View larger version:
* In this page
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Figure 1.
Relative age-group specific rates of all-cause mortality, Lyme disease incidence, and Lyme disease listed as a multiple or underlying cause of death?United States, 1999?2003
Of 114 records, Lyme disease was coded as the underlying cause of death for 23 (20%) and as a multiple cause of death for 91 (80%) (Table 1). There were no significant differences between decedents with Lyme disease coded as an underlying versus multiple cause of death with respect to age, sex, or residence or death in a with respect to age, sex, or residence or death in a Healthy People 2010 highly endemic state as previously defined (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin) [1]. Four (17%) records for which Lyme disease was coded as the underlying cause of death had Lyme disease listed in Part II of the death certificate, but it was coded as the underlying cause because the listed causal pathway in Part I of the death certificate lacked an accepted cause of death (eg, ?presumed natural disease?). Eleven (48%) death certificates with Lyme disease coded as the underlying cause of death were improperly completed, as evidenced by an implausible or ill-defined causal sequence of events (Table 1) [8]. Of the 12 certificates considered properly completed, the terminal events in the causal sequences were cardiopulmonary or cardiorespiratory arrest (3), respiratory arrest, failure, or anoxia (3), Lyme disease (2), coronary thrombosis (1), encephalopathy (1), seizure disorder (1), and stroke (1). Of these 12 certificates, 6 (50%) lacked enough information to evaluate the plausibility of the causal sequence, 2 (17%) listed other more plausible clinical explanations for the terminal event in Part II of the certificate (eg, atherosclerotic heart disease and chronic atrial fibrillation for the decedent with stroke), 2 (17%) contained disease processes in intervals substantially longer than that described in the scientific literature (eg, Lyme disease 5?10 years prior to seizure disorder onset), 1 (8%) listed a causal sequence not previously associated with Lyme disease (ie, coronary thrombosis and hypercoagulable state), and 1 (8%) listed a causal sequence possibly consistent with a prior case report (ie, ?respiratory failure? due to ?probable aspiration? due to ?severe cognitive deterioration? due to ?central nervous system Lymes disease? [sic]) [3].
View this table:
* In this window
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Table 1.
Direct Extraction of Part I of Death Certificates for which Lyme Disease Was Coded as the Underlying Cause of Death
Among the 91 records for which Lyme disease was coded as a multiple cause of death, 45 different diseases were coded as the underlying cause of death, including infectious diseases (eg, tuberculosis), malignancies (eg, colon, prostate), diabetes mellitus, nervous system diseases (eg, motor neuron disease, Parkinson's disease), circulatory system diseases (eg, acute myocardial infarction, atherosclerotic heart disease), and chronic obstructive pulmonary disease.
Previous SectionNext Section
DISCUSSION
In contrast to the 96,068 cases of Lyme disease reported to CDC during 1999?2003, Lyme disease was coded as an underlying cause of death on only 23 records. Decedents were predominately of an advanced age and age distribution that more closely approximates that of all-cause mortality than that of reported Lyme disease cases. Most terminal events on death certificates for which Lyme disease was the underlying cause of death were inconsistent with the well-characterized complications of Lyme disease and the rare published case reports of Lyme disease-associated mortality [3?6]. Additionally, the underlying causes of death when Lyme disease was listed as a multiple cause of death varied widely and also were inconsistent with the well-characterized complications of Lyme disease. While this analysis included data only through 2003, the number of deaths attributed to Lyme disease as reported in the MMWR Summary of Notifiable Diseases has remained consistent (available at http://www.cdc.gov/mmwr/PDF/wk/mm5754.pdf).
Mortality data are a fundamental component of disease surveillance. While standard forms and procedures are developed and recommended for nationwide use, improper completion of death certificates is not unique to our analysis [9]. Common errors include listing underlying or multiple causes of death in the wrong section, listing nonspecific processes, and listing inappropriate events in the causal sequence [9]. Sparse dedicated resources at the state level may limit follow-up of improperly or inaccurately completed death certificates, thereby decreasing the public health utility of this data source.
Without approval from every state to receive death record data, some relevant death records may have been excluded. However, these 5 states accounted for ∼1% of Lyme disease cases reported during 1999?2003, and this analysis captured 23 of 24 reported underlying deaths due to Lyme disease. In contrast, deaths attributed to Lyme disease likely are overestimated in this report because 9 certificates (8%) had uncertain terms listed such as ?Lyme disease?,? ?Lyme disease?past history,? or ?possible chronic Lyme disease.? Most importantly, we did not conduct medical chart reviews. Therefore, we were unable to confirm or deny the diagnosis of Lyme disease or the causal sequence leading to death.
Despite these limitations, our review of death records and death certificates supports the finding that Lyme disease is rare as a cause of death. Therefore, we strongly encourage health care providers to thoroughly document and report any death suspected to be caused by Lyme disease. Additionally, health care providers should be reminded to carefully and accurately complete death certificates as this data is a vital source of health information. Lastly, prompt diagnosis and treatment of persons infected with Borrelia burgdorferi are critical to the prevention of more serious illness and potential long-term complications.
A Review of Death Certificates Listing Lyme Disease as a Cause of Death in the United States
1. Kiersten J. Kugeler1,
2. Kevin S. Griffith1,
3. L. Hannah Gould1,
4. Ken Kochanek2,
5. Mark J. Delorey1,
6. Brad J. Biggerstaff1, and
7. Paul S. Mead1
+ Author Affiliations
1.
1Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, and the location is Fort Collins, CO, USA
2.
2Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, USA
1. Correspondence: Kevin S. Griffith, MD, MPH, 3150 Rampart Road, Fort Collins, CO 80521 (kkg8@cdc.gov).
Next Section
Abstract
Lyme disease was listed as an underlying or multiple cause of death on 114 death records during 1999?2003. Upon review, only 1 record was consistent with clinical manifestations of Lyme disease. This analysis indicates that Lyme disease is rare as a cause of death in the United States.
Lyme disease is a tickborne disease caused by Borrelia burgdorferi. In the United States, cases most commonly occur among persons aged 5?14 years and 45?54 years, and during the summer months in the northeastern, mid-Atlantic, and north-central states [1]. Clinically, early Lyme disease is characterized by fever, fatigue, headache, arthralgias, myalgias, and erythema migrans rash. Untreated, the infection may disseminate to cause various manifestations, including secondary skin lesions, cranial neuropathy, lymphocytic meningitis, radiculoneuritis, atrioventricular block, and oligoarthritis [2]. However, Lyme disease rarely has been reported as a cause of death in the United States [3?6].
The International Classification of Diseases (ICD) is the international standard for categorizing health and vital records, including death certificates. When the ICD was updated to version 10, which became effective in the United States in 1999, Lyme disease was given a unique code and thus could be captured as a cause of death on death certificates. During 1999?2003, the Morbidity and Mortality Weekly Report (MMWR) Summary of Notifiable Diseases listed 24 deaths (median per year, 5; range per year, 2?7) attributed to Lyme disease (available at http://www.cdc.gov/mmwr/mmwr_nd/index.html). To describe the epidemiology of deaths attributed to Lyme disease, we reviewed death records and death certificates in the United States during 1999?2003.
Previous SectionNext Section
METHODS
Death records from 1999 to 2003 for which Lyme disease was coded as an underlying or multiple cause of death were requested from the National Center for Health Statistics (NCHS). The underlying cause of death is defined as ?the disease or injury which initiated the chain of morbid events leading directly to death? [7]. A multiple cause of death is defined as ?any other significant condition which contributed to the fatal outcome, but was not related to the disease or condition directly causing death? [7]. Part I of a death certificate contains the causal sequence from the underlying cause to the terminal event, and Part II contains any other significant medical conditions that contributed, but were not directly related, to the causal sequence. Death certificates were coded according to the ICD-10 in state vital records departments using a computerized algorithm updated annually by NCHS. All records with ICD-10 codes assigned to Lyme disease (ie, A69.2 and L90.4) were requested. Data obtained included month and year of death, age, sex, state of residence, state of death, and ICD-10 codes for underlying and multiple causes of death. Copies of corresponding death certificates were requested from states and reviewed. Analyses were conducted using Microsoft Excel and SAS software, version 9.1. Death record analysis was exempt from human subjects review at CDC, but approval was obtained from states when required. Plausibility of association with Lyme disease was based on well-established clinical manifestations of Lyme disease published in the peer-reviewed literature.
Previous SectionNext Section
RESULTS
Approval to release death records during the study period was received from all states except Idaho, Iowa, Louisiana, Maine, and Tennessee. Among the 45 remaining states, Lyme disease was coded as an underlying or multiple cause of death for 119 records from 25 states. When requesting corresponding death certificates, one certificate could not be located by the state, one was never requested in error, two certificates did not contain a diagnosis or any wording of Lyme disease or B. burgdorferi infection, and one certificate was destroyed and the corresponding data deleted during our analysis due to expiration of the state's human subjects approval per state guidelines. Analyses were conducted on the remaining 114 death certificates.
The median age of decedents was 71 years (range: 19?99 years); 66 (58%) were male. The relative age-group specific rates of persons with Lyme disease listed as an underlying or multiple cause of death, all-cause mortality in the United States and incident cases of Lyme disease are shown in Figure 1. Deaths were evenly distributed throughout the study period (1999: n = 25; 2000: n = 23; 2001: n = 14; 2002: n = 25; 2003: n = 27) and across seasons. Deaths were reported among residents of Connecticut (19), Pennsylvania (18), New Jersey (13), New York (12), California (8), Massachusetts (5), Minnesota (5), Wisconsin (5), Virginia (4), Florida (3), Missouri (3), Texas (3), Maryland (2), Michigan (2), West Virginia (2), Alabama (1), Arkansas (1), Colorado (1), Iowa (1) (The death record and certificate for this decedent were from Kansas, but Iowa was listed as the state of residence.), Illinois (1), Indiana (1), North Carolina (1), North Dakota (1), South Carolina (1), and Washington (1).
Figure 1.
View larger version:
* In this page
* In a new window
* Download as PowerPoint Slide
Figure 1.
Relative age-group specific rates of all-cause mortality, Lyme disease incidence, and Lyme disease listed as a multiple or underlying cause of death?United States, 1999?2003
Of 114 records, Lyme disease was coded as the underlying cause of death for 23 (20%) and as a multiple cause of death for 91 (80%) (Table 1). There were no significant differences between decedents with Lyme disease coded as an underlying versus multiple cause of death with respect to age, sex, or residence or death in a with respect to age, sex, or residence or death in a Healthy People 2010 highly endemic state as previously defined (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin) [1]. Four (17%) records for which Lyme disease was coded as the underlying cause of death had Lyme disease listed in Part II of the death certificate, but it was coded as the underlying cause because the listed causal pathway in Part I of the death certificate lacked an accepted cause of death (eg, ?presumed natural disease?). Eleven (48%) death certificates with Lyme disease coded as the underlying cause of death were improperly completed, as evidenced by an implausible or ill-defined causal sequence of events (Table 1) [8]. Of the 12 certificates considered properly completed, the terminal events in the causal sequences were cardiopulmonary or cardiorespiratory arrest (3), respiratory arrest, failure, or anoxia (3), Lyme disease (2), coronary thrombosis (1), encephalopathy (1), seizure disorder (1), and stroke (1). Of these 12 certificates, 6 (50%) lacked enough information to evaluate the plausibility of the causal sequence, 2 (17%) listed other more plausible clinical explanations for the terminal event in Part II of the certificate (eg, atherosclerotic heart disease and chronic atrial fibrillation for the decedent with stroke), 2 (17%) contained disease processes in intervals substantially longer than that described in the scientific literature (eg, Lyme disease 5?10 years prior to seizure disorder onset), 1 (8%) listed a causal sequence not previously associated with Lyme disease (ie, coronary thrombosis and hypercoagulable state), and 1 (8%) listed a causal sequence possibly consistent with a prior case report (ie, ?respiratory failure? due to ?probable aspiration? due to ?severe cognitive deterioration? due to ?central nervous system Lymes disease? [sic]) [3].
View this table:
* In this window
* In a new window
Table 1.
Direct Extraction of Part I of Death Certificates for which Lyme Disease Was Coded as the Underlying Cause of Death
Among the 91 records for which Lyme disease was coded as a multiple cause of death, 45 different diseases were coded as the underlying cause of death, including infectious diseases (eg, tuberculosis), malignancies (eg, colon, prostate), diabetes mellitus, nervous system diseases (eg, motor neuron disease, Parkinson's disease), circulatory system diseases (eg, acute myocardial infarction, atherosclerotic heart disease), and chronic obstructive pulmonary disease.
Previous SectionNext Section
DISCUSSION
In contrast to the 96,068 cases of Lyme disease reported to CDC during 1999?2003, Lyme disease was coded as an underlying cause of death on only 23 records. Decedents were predominately of an advanced age and age distribution that more closely approximates that of all-cause mortality than that of reported Lyme disease cases. Most terminal events on death certificates for which Lyme disease was the underlying cause of death were inconsistent with the well-characterized complications of Lyme disease and the rare published case reports of Lyme disease-associated mortality [3?6]. Additionally, the underlying causes of death when Lyme disease was listed as a multiple cause of death varied widely and also were inconsistent with the well-characterized complications of Lyme disease. While this analysis included data only through 2003, the number of deaths attributed to Lyme disease as reported in the MMWR Summary of Notifiable Diseases has remained consistent (available at http://www.cdc.gov/mmwr/PDF/wk/mm5754.pdf).
Mortality data are a fundamental component of disease surveillance. While standard forms and procedures are developed and recommended for nationwide use, improper completion of death certificates is not unique to our analysis [9]. Common errors include listing underlying or multiple causes of death in the wrong section, listing nonspecific processes, and listing inappropriate events in the causal sequence [9]. Sparse dedicated resources at the state level may limit follow-up of improperly or inaccurately completed death certificates, thereby decreasing the public health utility of this data source.
Without approval from every state to receive death record data, some relevant death records may have been excluded. However, these 5 states accounted for ∼1% of Lyme disease cases reported during 1999?2003, and this analysis captured 23 of 24 reported underlying deaths due to Lyme disease. In contrast, deaths attributed to Lyme disease likely are overestimated in this report because 9 certificates (8%) had uncertain terms listed such as ?Lyme disease?,? ?Lyme disease?past history,? or ?possible chronic Lyme disease.? Most importantly, we did not conduct medical chart reviews. Therefore, we were unable to confirm or deny the diagnosis of Lyme disease or the causal sequence leading to death.
Despite these limitations, our review of death records and death certificates supports the finding that Lyme disease is rare as a cause of death. Therefore, we strongly encourage health care providers to thoroughly document and report any death suspected to be caused by Lyme disease. Additionally, health care providers should be reminded to carefully and accurately complete death certificates as this data is a vital source of health information. Lastly, prompt diagnosis and treatment of persons infected with Borrelia burgdorferi are critical to the prevention of more serious illness and potential long-term complications.