Quantification of risk factors for herpes zoster: population based case-control study.


Forbes, HJ; Bhaskaran, K; Thomas, SL; Smeeth, L; Clayton, T; Langan, SM; (2014) Quantification of risk factors for herpes zoster: population based case-control study. BMJ (Clinical research ed), 348. g2911. ISSN 0959-8138 DOI: https://doi.org/10.1136/bmj.g2911

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Abstract

OBJECTIVES To quantify the effects of possible risk factors for herpes zoster at different ages. DESIGN Case-control study. SETTING UK Clinical Practice Research Datalink primary care data. PARTICIPANTS 144 959 adults diagnosed with zoster between 2000 and 2011; 549 336 age, sex, and practice matched controls. MAIN OUTCOME MEASURES Conditional logistic regression was used to generate adjusted odds ratios to estimate the strength of association of each potential risk factor with zoster and assess effect modification by age. RESULTS The median age of the cases and controls was 62 years. Factors associated with increased risk of zoster included rheumatoid arthritis (3111 (2.1%) v 8029 (1.5%); adjusted odds ratio 1.46, 99% confidence interval 1.38 to 1.55), inflammatory bowel disease (1851 (1.3%) v 5118 (0.9%); 1.36, 1.26 to 1.46), chronic obstructive pulmonary disease (6815 (4.7%) v 20 201 (3.7%); 1.32, 1.27 to 1.37), asthma (10 243 (7.1%) v 31 865 (5.8%); 1.21, 1.17 to 1.25), chronic kidney disease (8724 (6.0%) v 29 437 (5.4%); 1.14, 1.09 to 1.18), and depression (6830 (4.7%) v 22 052 (4.0%); 1.15, 1.10 to 1.20). Type 1, but not type 2, diabetes showed some association with zoster (adjusted odds ratio 1.27, 1.07 to 1.50). The relative effects of many assessed risk factors were larger in younger patients. Patients with severely immunosuppressive conditions were at greatest risk of zoster-for example, patients with lymphoma (adjusted odds ratio 3.90, 3.21 to 4.74) and myeloma (2.16, 1.84 to 2.53), who are not eligible for zoster vaccination. CONCLUSIONS A range of conditions were associated with increased risk of zoster. In general, the increased risk was proportionally greater in younger age groups. Current vaccines are contraindicated in people at the greatest risk of zoster, highlighting the need for alternative risk reduction strategies in these groups.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
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PubMed ID: 25134101
Web of Science ID: 336146200003
URI: http://researchonline.lshtm.ac.uk/id/eprint/1883936

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