title: Effect of latitude on the rate of change in incidence of Lyme disease in the United States.
abstract: BACKGROUND
  Tick-borne illnesses represent an important class of emerging zoonoses, with climate change projected to increase the geographic range within which tick-borne zoonoses might become endemic. We evaluated the impact of latitude on the rate of change in the incidence of Lyme disease in the United States, using publicly available data.
  
  
  METHODS
  We estimated state-level year-on-year incidence rate ratios (IRRs) for Lyme disease for the period 1993 to 2007 using Poisson regression methods. We evaluated between-state heterogeneity in IRRs using a random-effects meta-analytic approach. We identified state-level characteristics associated with increasing incidence using random-effects meta-regression.
  
  
  RESULTS
  The incidence of Lyme disease in the US increased by about 80% between 1993 and 2007 (IRR per year 1.049, 95% CI [confidence interval] 1.048 to 1.050). There was marked between-state heterogeneity in the average incidence of Lyme disease, ranging from 0.008 per 100 000 person-years in Colorado to 75 per 100 000 in Connecticut, and significant between-state heterogeneity in temporal trends (p < 0.001). In multivariable meta-regression models, increasing incidence showed a linear association with state latitude and population density. These 2 factors explained 27% of the between-state variation in IRRs. No independent association was identified for other state-level characteristics.
  
  
  CONCLUSIONS
  Lyme disease incidence increased in the US as a whole during the study period, but the changes were not uniform. Marked increases were identified in northern-most states, whereas southern states experienced stable or declining rates of Lyme disease.
authors: The Dalla Lana School of Public Health, Toronto, Ont.
authors: Ashleigh R
authors: AR
authors: Tuite
authors: The Dalla Lana School of Public Health, Toronto, Ont. ; The Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ont.
authors: Amy L
authors: AL
authors: Greer
authors: The Dalla Lana School of Public Health, Toronto, Ont. ; The Institute of Health Policy, Management and Evaluation, and the Department of Medicine, University of Toronto, Toronto, Ont.
authors: David N
authors: DN
authors: Fisman