An appraisal of health datasets to enhance the surveillance of Lyme disease in the United Kingdom



Tulloch, JS
(2019) An appraisal of health datasets to enhance the surveillance of Lyme disease in the United Kingdom. PhD thesis, University of Liverpool.

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Abstract

Lyme disease is a tick-borne disease of increasing global public health interest. Clinical presentation is varied, posing challenges for case definition. Currently national incidence figures for the United Kingdom (UK) are derived from two-tier confirmatory laboratory diagnostic results. These figures have the potential to underestimate incidence as clinical cases managed without diagnostic investigation are unrecorded. This thesis aimed to identify and evaluate a variety of datasets for their ability to describe the incidence and sociodemographics of Lyme disease cases in the UK, and to assess whether they could be utilised in future national surveillance programmes. The datasets analysed were: Public Health England (PHE)’s Lyme disease diagnostic laboratory, PHE’s laboratory surveillance system, hospital episode statistics data for England and Wales, an electronic health records database of primary care in the UK, Twitter, and the Small Animals Veterinary Surveillance Network (SAVSNET). A generalised Lyme disease population could be described from these data. This population had a bimodal age distribution, was predominately white, was from rural areas, and increasingly from areas with lower societal deprivation. Geographic distribution of cases could be described for England and Wales and showed the highest incidence of disease in southern central to south western England. These data showed an increasing incidence of Lyme disease. The relative incidence of Lyme disease cases varied between datasets, with the primary care data having the largest incidence of 4.42 per 100,000 person-years (95% CI 4.23-4.67). Multiplication factors were described between the three datasets of routinely collected health care data. The most important being a multiplication factor of 2.35 (95% CI 1.81-2.88) between laboratory-confirmed incidence and primary care incidence in England and Wales. The results from this thesis start to describe the epidemiological picture of Lyme disease in the UK; specifically identified as a research gap by the NICE guidelines. They will provide a platform for the many unanswered questions about the changing landscape of Lyme disease in the UK. It was concluded that a combination of health datasets could be used for future Lyme disease surveillance systems in the UK. Ideally this would include laboratory and primary care data. Until this is in place, the multiplication factor can be used to estimate the national incidence of Lyme disease and the potential burden it places on the National Health Service and the patients it afflicts.

Item Type: Thesis (PhD)
Divisions: Faculty of Health and Life Sciences
Depositing User: Symplectic Admin
Date Deposited: 15 Jul 2019 11:09
Last Modified: 02 Oct 2021 07:32
DOI: 10.17638/03046553
Supervisors:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3046553