Racial differences in knowledge, attitudes toward vaccination, and risk practices around Lyme disease in the United States.

Introduction: Lyme disease (LD) incidence in the United States is highly regional, with most cases occurring in 16 high-incidence jurisdictions. LD incidence and severity of disease have been found to vary by race. This study describes racial differences in knowledge, attitudes toward vaccination, and risk practices related to LD. Methods: Four web-based surveys were conducted with adults and caregivers of children in high-incidence jurisdictions and 10 states neighboring them. Respondents were recruited via an established online panel to represent the general population. Self-reported race was pooled into 3 categories: 'White', 'Black or African American', and 'Other' for analysis. Analyses were conducted separately for each jurisdiction (high-incidence vs. neighboring) and respondent type (adult vs. caregiver). Results: The final sample across all surveys included 2,249 respondents who identified as White, 493 respondents who identified as Black or African American, and 674 respondents of other races. White respondents were older, had higher incomes, and were likelier to live in small cities and rural areas. Though attitudes toward vaccination in general were similar between racial categories, when differences were present, Black respondents were more likely to have concerns about vaccines than White respondents. In all surveys, White respondents engaged in more outdoor activities than Black respondents and performed these activities more often. However, both White adults and caregivers in high-incidence jurisdictions were significantly less likely to have occupations with primarily outdoor work than corresponding respondents in other racial groups. Black respondents also had lower knowledge about LD than White respondents across all surveys. This difference was significant after adjusting for state incidence level and urbanicity. Conclusion: There are some racial differences in knowledge, attitudes, and practices around LD, with White respondents reported having higher knowledge of LD, less concerns about vaccines, and higher frequency of risk practices. These differences might contribute to racial disparities in LD outcomes.