12 Worst States for Lyme Disease

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12. Maryland
>Incidence of Lyme disease:
16.0 (per 100,000 residents)
>Confirmed cases: 957 (9th highest)
>Pct. population rural: 12.8%
>Pct. adults physically active: 76.8% (24th highest)

Maryland is one of several Mid-Atlantic states where Lyme disease is more than twice as common as it is nationwide. There were 16.0 confirmed cases of the disease in 2014 for every 100,000 residents, far more than the national incidence of 7.9 cases per 100,000 people. While Lyme disease is still relatively common in Maryland, 2014 marked the second lowest rate in the last 10 years. Infections per capita peaked in the state in 2007, when there were 45.8 confirmed infections for every 100,000 state residents.

Earlier this year, Maryland Governor Larry Hogan signed the state’s first bill related to Lyme disease into law. The new law requires that doctors provide a written note to patients explaining that negative tests results do not necessarily mean the patient is free of the disease. The law illustrates the ambiguities surrounding Lyme disease testing and diagnosis.

11. Minnesota
>Incidence of Lyme disease:
16.4 (per 100,000 residents)
>Confirmed cases: 896 (10th highest)
>Pct. population rural: 26.7%
>Pct. adults physically active: 80.5% (8th highest)

There were 896 confirmed cases of Lyme disease and another 520 likely cases in Minnesota in 2014 alone. Counties at the highest risk of Lyme disease are located in the northern half of the state, and along the border with Wisconsin, a state with a similar Lyme incidence rate. The disease is contracted from ticks that thrive in the region’s many forested areas. More than a quarter of the state’s population lives in rural areas, and 80.5% of Minnesota adults lead physically active lives. While remaining active can be an important component of a healthy lifestyle, it can also put individuals at a greater risk of contracting Lyme disease, specifically in wooded areas.

Last year, a Twin Cities man died after his heart suddenly stopped due to Lyme carditis, a rare complication that can be triggered by Lyme disease.

10. Wisconsin
>Incidence of Lyme disease:
17.2 (per 100,000 residents)
>Confirmed cases: 991 (7th highest)
>Pct. population rural: 29.8%
>Pct. adults physically active: 78.3% (17th highest)

Wisconsin is the worst state in the Midwest for Lyme disease. There were 17.2 confirmed cases of the disease for every 100,000 state residents in 2014, well more than double the nationwide Lyme disease infection rate. Incidence of the disease peaks in summer months — and 2014 was no different in Wisconsin. More than half of all confirmed cases that year were reported in June and July.

Though Lyme is more common in Wisconsin than in much of the country, the 2014 incidence rate marked a 10-year low in the state. There were 34.8% fewer confirmed cases per capita in 2014 than there were a decade prior. The incidence rate in Wisconsin peaked in 2010, when there were 44 confirmed cases for every 100,000 state residents.

Earlier this year, Assembly Bill 768, which would have implemented a standard set of rules related to diagnosing and treating Lyme disease, failed to pass in the state senate.

9. New Jersey
>Incidence of Lyme disease:
29.0 (per 100,000 residents)
>Confirmed cases: 2,589 (4th highest)
>Pct. population rural: 5.3%
>Pct. adults physically active: 75.9% (22nd lowest)

There were 2,589 confirmed cases of Lyme disease and another 697 probable cases in New Jersey in 2014. Not counting the unconfirmed cases, the incidence rate of 29 cases per 100,000 state residents is the ninth highest of any state in the country. Though only about 5% of New Jersey residents live in rural areas, nearly 95% of people in the Garden State have easy access to areas for physical activity, the largest share of any state in the country. Hoffmann explained that even suburban backyards, parks, and public spaces can be suitable habitats for Lyme-carrying ticks.

As was the case nationwide, the Lyme disease infection rate peaked in New Jersey in 2009. That year, there were 4,598 confirmed cases, or 52.8 incidents for every 100,000 state residents.