Slatculescu Andreea M, Pugliese Michael, Sander Beate, Zinszer Kate, Nelder Mark P, Russell Curtis B, Kulkarni Manisha A
Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
ICES uOttawa, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.
Vector Borne Zoonotic Dis. 2022 Dec;22(12):572-581. doi: 10.1089/vbz.2022.0044. Epub 2022 Nov 15.
Lyme disease (LD) is the most common tick-borne illness in North America. LD is acquired through exposure to the tick vector, , known as the blacklegged tick. In Canada, LD is rapidly emerging, with the establishment of in many newly endemic regions posing a growing risk to local communities. In the Canadian context, many environmental and socioeconomic risk factors for human LD infection are yet to be ascertained and the degree of risk associated with residential and community exposure to ticks is not well known. We conducted a matched case-control study in southeastern Ontario, using LD patient data from provincial laboratory databases and uninfected population controls from 2014 to 2018. We aimed to identify area-level risk factors for LD and associations with residence in environmental risk areas, defined as areas with high model-predicted probability of occurrence, using the neighborhood dissemination area as the unit of analysis. Using multivariable conditional logistic regression analysis, we identified that patients with LD had higher odds (odds ratio, OR; 95% confidence interval, CI) of living in neighborhoods with high probability of tick occurrence in the environment (OR = 2.2; 95% CI: 2.0-2.5), low walkability (OR = 1.6; 95% CI: 1.2-2.1), low material deprivation (OR = 1.4; 95% CI: 1.2-1.7), and low ethnic concentration (OR = 8.1; 95% CI: 6.7-9.9). We also found that the odds of LD infection for individuals residing in environmental risk areas was highest for those living in public health units (PHUs) with <250,000 population (OR = 3.0; 95% CI: 2.4-3.9) compared to those living in PHUs with >1,000,000 population (OR = 1.5; 95% CI: 1.1-2.1). This study shows that odds of human LD infection in Ontario, Canada is higher in less urbanized areas with higher socioeconomic status and indicates that exposure to ticks around the home residence or neighborhood is linked to increased odds of LD.
莱姆病（LD）是北美最常见的蜱传疾病。LD通过接触蜱虫媒介，即黑脚蜱而感染。在加拿大，莱姆病正在迅速蔓延，许多新的流行地区的出现对当地社区构成了越来越大的风险。在加拿大的背景下，许多人类感染莱姆病的环境和社会经济风险因素尚未确定，与居住和社区接触蜱虫相关的风险程度也不为人所知。我们在安大略省东南部进行了一项匹配病例对照研究，使用了2014年至2018年省级实验室数据库中的莱姆病患者数据和未感染人群作为对照。我们旨在确定莱姆病的区域层面风险因素，以及与居住在环境风险区域（定义为模型预测蜱虫出现概率高的区域）的关联，以邻里传播区域作为分析单位。通过多变量条件逻辑回归分析，我们发现莱姆病患者居住在环境中蜱虫出现概率高的社区的几率更高（优势比，OR；95%置信区间，CI）（OR = 2.2；95% CI：2.0 - 2.5），可步行性低（OR = 1.6；95% CI：1.2 - 2.1），物质匮乏程度低（OR = 1.4；95% CI：1.2 - 1.7），以及种族集中度低（OR = 8.1；95% CI：6.7 - 9.9）。我们还发现，与居住在人口超过100万的公共卫生单位（PHU）的人相比，居住在人口少于25万的公共卫生单位的人，居住在环境风险区域感染莱姆病的几率最高（OR = 3.0；95% CI：2.4 - 3.9）（OR = 1.5；95% CI：1.1 - 2.1）。这项研究表明，在加拿大安大略省，社会经济地位较高的城市化程度较低的地区，人类感染莱姆病的几率更高，并且表明在家居住所或社区周围接触蜱虫与莱姆病感染几率增加有关。
