Worst States for Lyme Disease

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10. West Virginia
> Avg. new Lyme cases per year: 24.9 confirmed cases per 100,000 people
> Total cases in 2018: 671 (554 confirmed, 117 probable)
> Worst year since 2009: 30.7 per 100,000 in 2018
> Physically active adults: 71.1% (5th lowest)
> Uninsured rate: 6.4% (17th lowest)

Lyme disease has become much more common in West Virginia in recent years. As recently as 2012, there were only 4.4 cases for every 100,000 people. As of 2018, there were 30.7 confirmed cases of the disease for every 100,000 state residents — a nearly 600% increase.

Deer tick populations, which carry Lyme disease, have grown in West Virginia in recent years. In March 2018, Gov. Jim Justice signed legislation that prevents insurance companies from denying coverage for Lyme disease treatment and care.

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9. Wisconsin
> Avg. new Lyme cases per year: 25.4 confirmed cases per 100,000 people
> Total cases in 2018: 1,869 (1,121 confirmed, 748 probable)
> Worst year since 2009: 44.0 per 100,000 in 2010
> Physically active adults: 79.2% (13th highest)
> Uninsured rate: 5.5% (11th lowest)

Wisconsin is the only state in the Midwest and one of nine states nationwide with an average of more than 25 new cases of Lyme disease for every 100,000 people annually. Infections have become less common in the state recently, as there were only 19.3 cases for every 100,000 people in 2018, down 38% from 31.0 cases per 100,000 people in 2017.

People who spend more time outdoors are at increased risk of being bitten and infected by disease-carrying ticks. In Wisconsin, nearly 80% of adults are regularly physically active, a larger share than in the majority of states.

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8. Connecticut
> Avg. new Lyme cases per year: 36.2 confirmed cases per 100,000 people
> Total cases in 2018: 1,859 (1,268 confirmed, 591 probable)
> Worst year since 2009: 78.2 per 100,000 in 2009
> Physically active adults: 79.6% (11th highest)
> Uninsured rate: 5.3% (7th lowest)

Lyme disease was first identified in Connecticut in the 1970s, and today, the state remains one of the hotspots for the disease. There are 36.2 new infections for every 100,000 people annually in Connecticut, more than four times the national incidence rate of 8.1 new infections per 100,000.

Encouragingly, cases of the disease are becoming less common in the state. There were only 35.5 cases for every 100,000 people in 2018, down 55% from a 10-year high of 78.2 cases per 100,000 in 2009. However, experts warn that tick populations may surge this year in the state due to the mild winter and cool spring.

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7. New Jersey
> Avg. new Lyme cases per year: 36.6 confirmed cases per 100,000 people
> Total cases in 2018: 4,000 (2,876 confirmed, 1,124 probable)
> Worst year since 2009: 52.8 per 100,000 in 2009
> Physically active adults: 74.0% (12th lowest)
> Uninsured rate: 7.4% (23rd lowest)

The humidity common in much of the mid-Atlantic region allows tick populations to thrive. In New Jersey, nearly 2,900 people were infected with Lyme disease by deer ticks, and an additional 1,100 people were likely infected. Over the last three years, there has been an average of 36.6 confirmed cases of Lyme disease for every 100,000 people in the state annually, well above the comparable 8.1 per 100,000 national average.

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6. Delaware
> Avg. new Lyme cases per year: 45.7 confirmed cases per 100,000 people
> Total cases in 2018: 520 (505 confirmed, 15 probable)
> Worst year since 2009: 111.2 per 100,000 in 2009
> Physically active adults: 72.3% (7th lowest)
> Uninsured rate: 5.7% (14th lowest)

Confirmed cases of Lyme disease have climbed in recent years in Delaware. There were 505 confirmed cases in the state in 2018 alone, or 52.2 infections for every 100,000 people — a 19% increase from the previous year. Still, the incidence rate lags well behind the highs recorded in the state from 2009 to 2011, when Delaware led the nation in Lyme disease incidence rates.

Though cases of the infection have been identified in each of the state’s three counties, cases tend to be concentrated in New Castle, the state’s northernmost county that sits across the Delaware River from New Jersey and shares a border with Maryland and Pennsylvania — three other states that rank on this list.