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The growth in incidence and geographic spread is largely attributed to climate and land\u2010use changes that support the tick vector and thereby increase disease risk. Despite a wide range of symptoms displayed by Lyme borreliosis patients, the demographic patterns in clinical manifestations and seasonal case timing have not been thoroughly investigated and may result from differences in exposure, immunity and pathogenesis. We analysed 25\u2009years of surveillance data from Norway, supplemented by population demography data, using a Bayesian modelling framework. The analyses aimed to detect differences in case seasonality and clinical manifestations of Lyme borreliosis across age and sex differentiated patient groups. The results showed a bimodal pattern of incidence over age, where children (0\u20139\u2009years) had the highest incidence, young adults (20\u201329\u2009years) had low incidence and older adults had a second incidence peak in the ages 70\u201379\u2009years. Youth (0\u201319\u2009years) presented with a higher proportion of neuroborreliosis cases and a lower proportion of arthritic manifestations compared to adults (20+ years). Adult males had a higher overall incidence than adult females and a higher proportion of arthritis cases. The seasonal timing of Lyme borreliosis consistently occurred around 4.4\u2009weeks earlier in youth compared to adults, regardless of clinical manifestation. All demographic groups exhibited a shift towards an earlier seasonal timing over the 25\u2010year study period, which appeared unrelated to changes in population demographics. However, the disproportionate incidence of Lyme borreliosis in seniors requires increased public awareness and knowledge about this high\u2010risk group as the population continues to age concurrently with disease emergence. Our findings highlight the importance of considering patient demographics when analysing the emergence and seasonal patterns of vector\u2010borne diseases using long\u2010term surveillance data.<\/jats:p>","DOI":"10.1111\/zph.13073","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T12:48:35Z","timestamp":1689598115000},"page":"647-655","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Demographic patterns in Lyme borreliosis seasonality over 25\u2009years"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-3413","authenticated-orcid":false,"given":"Asena","family":"Goren","sequence":"first","affiliation":[{"name":"Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES) University of Oslo Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8993-7382","authenticated-orcid":false,"given":"Atle","family":"Mysterud","sequence":"additional","affiliation":[{"name":"Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES) University of Oslo Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8527-4892","authenticated-orcid":false,"given":"Solveig","family":"Jore","sequence":"additional","affiliation":[{"name":"Zoonotic, Food &amp; Waterborne Infections The Norwegian Public Health Institute Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3798-5267","authenticated-orcid":false,"given":"Hildegunn","family":"Viljugrein","sequence":"additional","affiliation":[{"name":"Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES) University of Oslo Oslo Norway"},{"name":"Norwegian Veterinary Institute \u00c5s Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8272-865X","authenticated-orcid":false,"given":"Haakon","family":"Bakka","sequence":"additional","affiliation":[{"name":"Norwegian Veterinary Institute \u00c5s Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1197-5818","authenticated-orcid":false,"given":"Yngvild","family":"Vindenes","sequence":"additional","affiliation":[{"name":"Department of Biosciences, Centre for Ecological and Evolutionary Synthesis (CEES) University of Oslo Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spasta.2019.01.002"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2006.0533"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199511163332004"},{"key":"e_1_2_10_5_1","unstructured":"Berstad A. 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