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Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study

BMJ 2018; 361 doi: (Published 30 May 2018) Cite this as: BMJ 2018;361:k1998
  1. Niels Obel, medical doctor and professor1,
  2. Ram B Dessau, medical doctor2,
  3. Karen A Krogfelt, professor3,
  4. Jacob Bodilsen, medical doctor4,
  5. Nanna S Andersen, medical doctor5,
  6. Jens K Møller, medical doctor and professor6,
  7. Casper Roed, medical doctor1,
  8. Lars H Omland, medical doctor1,
  9. Claus B Christiansen, medical doctor7,
  10. Svend Ellermann-Eriksen, medical doctor and professor8,
  11. Jette M Bangsborg, medical doctor9,
  12. Klaus Hansen, medical doctor10,
  13. Thomas L Benfield, medical doctor and professor11,
  14. Kenneth J Rothman, professor12 13,
  15. Henrik T Sørensen, medical doctor and professor12,
  16. Christian Ø Andersen, medical doctor14,
  17. Anne-Mette Lebech, medical doctor1
  1. 1Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
  2. 2Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
  3. 3Bacteria, Parasites and Fungi Department, Statens Serum Institute, Copenhagen, Denmark
  4. 4Department of Clinical Microbiology and Infectious Diseases, Aalborg University hospital, Aalborg, Denmark
  5. 5Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark
  6. 6Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
  7. 7Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  8. 8Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
  9. 9Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
  10. 10Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  11. 11Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
  12. 12Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  13. 13Department of Epidemiology, Boston University, Boston, MA, USA
  14. 14Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
  1. Correspondence to: N Obel niels.obel{at}
  • Accepted 16 April 2018


Objective To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population.

Design Nationwide population based cohort study using national registers.

Setting Denmark.

Participants All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670).

Main outcome measures Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes.

Results Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference −0.22, 95% confidence interval −0.45 to 0.02, in-hospital days/year; 0.37, −0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, −2.1% to 5.1%), income (difference −1000, −20 000 to 18 000, Danish kroner), days of sick leave (difference −0.3, −3.5 to 3.0, per year), rates of receipt of a disability pension (difference −0.9%, −3.2% to 1.3%), and number of children (difference –0.10, −0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%).

Conclusion A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.


  • Contributors: All authors contributed to the design, analysis, interpretation of data, drafting the article, or revising it critically for important intellectual content and approved the final version to be published. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. NO and AML are the guarantors.

  • Funding: The study was sponsored by the Danish Council for Independent Research (grant number: 6110-00173B). HTS was supported by the PROCRIN program. The sponsors had no influence on the preparation, design, analysis, and reporting of this study.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work other than those listed above; KH has received royalties from Thermo Fisher; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the Danish Data Protection Agency and the National Board of Health (RH-2015-285, I-Suite No: 04297).

  • Data sharing: Data are stored in Statistics Denmark and according to Danish data protection cannot be shared.

  • Transparency: The guarantors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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