Infectious Disease
What distinguishes those who get lyme disease? a case-control study of knowledge, attitudes, and practices in canada Danny Szaroz* Danny Szaroz Szaroz Szaroz Szaroz Szaroz Szaroz Szaroz Szaroz Szaroz University of Montreal
The rapid rise in the incidence of Lyme disease (LD) in Canada, indicates that more public health action is needed to target high-risk populations. In regions with increasing endemic risk, it is important to understand how the independent contributions of knowledge, attitudes and practices affect health behaviour and disease status.
The study’s aim is to identify characteristics associated with higher levels of LD knowledge and protective behaviours.
We conducted a matched case-control study in Kingston, Ontario and Lunenburg, Nova Scotia, using LD data from geographically stratified paper surveys administered in emergency rooms and primary care clinics from 2019 to 2024. Frequency matching was used based on age group, biological sex, and site. Cases were defined as individuals who have been diagnosed with early-stage LD while controls were defined as individuals who did not have a previous diagnosis of LD. Questionnaire aimed to collect information on sociodemographic, KAP, and other risk factors for LD like income and education. We compared domain-specific Principal Component Analysis (PCA) for KAP domains to preserve within domain structure, to the profiling of KAP scores as a global composite score, treating KAP as a unified construct. Disease outcome is regressed on KAP via logistic modelling adjusted for confounding.
Domain-specific dimensionality reduction revealed targeted associations generalized by composite scoring approach, primarily revealing confounding by socio-economic factors. Crude analyses with domain-specific comparisons revealed that knowledge showed no association while the attitudes revealed protective effects. After adjusting for confounding, this association reversed with knowledge showing strong protective effects and attitudes showing no significant association. Among socio-economic factors, ‘postgraduate education’ conferred 97% lower odds of disease while low income (<$50,000) was associated with 93% higher odds.
This study will offer insights into how variations in socioeconomic status exerts confounding influence, masking the underlying association between heath knowledge and LD status. The findings can be used to inform and guide the development of targeted LD prevention strategies including education campaigns in vulnerable areas, to help reduce the risk of infections within the Canadian population.