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Reported cases of
Lyme disease in Hunterdon County, New Jersey, increased almost 200% from 75 (67/100,000 population) in 1992 to 216 (193/100,000 population) in 1993. For evaluation of risk factors for
Lyme disease and for determination of the cause of this increase, a case-control study was conducted, and the reporting practices of physicians’ offices were evaluated. For cases reported in 1993, age and sex distribution, month of
disease onset, and proportion of cases with erythema migrans rash were within expected limits. Analysis of age-matched case-control data showed that rural residence; clearing periresidential brush during spring and summer months; and the presence of rock walls, woods, deer, or a bird feeder on residential property were associated with incident
Lyme disease. A review of physician reporting patterns suggested that the increase in reported cases in 1993 was due to improved reporting as well as to an increase in the numbers of patients diagnosed with
Lyme disease. In addition, substantial underreporting of
Lyme disease by physicians’ offices was found.