Worst States for Lyme Disease

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15. District of Columbia
> Avg. new Lyme cases per year: 8.9 confirmed cases per 100,000 people
> Total cases in 2018: 79 (57 confirmed, 22 probable)
> Worst year since 2009: 11.6 per 100,000 in 2015
> Physically active adults: 81.6% (6th highest)
> Uninsured rate: 3.2% (the lowest)

The humidity in the spring and summer seasons in Washington, D.C., provides ideal conditions for ticks — particularly deer ticks that carry Lyme disease. Based on the number of infections reported between 2016 and 2018, there are an average of 8.9 cases of Lyme disease in Washington D.C. annually for every 100,000 residents, a higher incidence rate than in all but 14 states.

Even in urban areas, disease carrying ticks can live in backyards and parks. While in much of the country Lyme disease is spread by deer populations who then pass the disease on to ticks, in urban areas like Washington, the disease is likely passed to ticks mostly by mice.

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14. Virginia
> Avg. new Lyme cases per year: 10.9 confirmed cases per 100,000 people
> Total cases in 2018: 1,139 (744 confirmed, 395 probable)
> Worst year since 2009: 13.1 per 100,000 in 2015
> Physically active adults: 77.1% (23rd highest)
> Uninsured rate: 8.8% (19th highest)

There are an average of 10.9 cases of Lyme disease for every 100,000 people in Virginia annually. The average annual incidence rate only accounts for confirmed cases and does not include probably cases, which numbered nearly 400 in 2018. Not all cases of Lyme disease are confirmed by lab tests, as testing for the infection is done by checking for antibodies for the disease, which can take several weeks after the initial infection to develop.

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13. New York
> Avg. new Lyme cases per year: 14.5 confirmed cases per 100,000 people
> Total cases in 2018: 3,638 (2,446 confirmed, 1,192 probable)
> Worst year since 2009: 21.2 per 100,000 in 2009
> Physically active adults: 75.3% (17th lowest)
> Uninsured rate: 5.4% (9th lowest)

New York state ranks among the worst places in the country for Lyme disease. There are an average of 14.5 cases of the disease for every 100,000 people in the state annually. Lyme disease used to be more of a problem in southern parts of the state, including the lower Hudson Valley and Long Island. In recent years, however, the disease has been moving farther north, into central New York and the Adirondack region.

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12. Maryland
> Avg. new Lyme cases per year: 18.6 confirmed cases per 100,000 people
> Total cases in 2018: 1,382 (894 confirmed, 488 probable)
> Worst year since 2009: 25.7 per 100,000 in 2009
> Physically active adults: 77.6% (22nd highest)
> Uninsured rate: 6.0% (15th lowest)

Over the last three years, there has been an average of 18.6 confirmed cases of Lyme disease for every 100,000 people in Maryland annually. While the incidence of the infection is higher than in most of the country, infections have become less common in recent years. There were only 14.8 cases for every 100,000 people in 2018, down from 19.7 in 2017 and 21.2 in 2016. Over the last decade of data, the worst year for Lyme disease in the state was 2009, when there were 25.7 new infections for every 100,000 residents.

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11. Minnesota
> Avg. new Lyme cases per year: 21.9 confirmed cases per 100,000 people
> Total cases in 2018: 1,541 (950 confirmed, 591 probable)
> Worst year since 2009: 26.4 per 100,000 in 2013
> Physically active adults: 79.9% (10th highest)
> Uninsured rate: 4.4% (5th lowest)

Lyme disease tends to be more common in Northeastern and mid-Atlantic states, but Minnesota is one of a few Midwestern states with a near nation-leading incidence rate of the infection. There are an average of 21.9 new infections for every 100,000 people in the state annually, more than double the average infection rate nationwide of 8.1 per 100,000.

Minnesota residents are more likely to contract Lyme disease than most Americans and are also more likely to be able to seek and afford treatment. Minnesota is one of only seven states where less than than 5% of the population is without health insurance.