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Chronic Medical Conditions as Risk Factors for Herpes Zoster

      Abstract

      Objective

      To determine the degree to which chronic conditions might contribute to the unexplained burden of herpes zoster.

      Methods

      We conducted a case-control study using MarketScan data from January 1, 2007, through December 31, 2007, to investigate chronic conditions as risk factors for herpes zoster among persons 20 to 64 years old. Cases were enrollees with a herpes zoster diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 053.xx), and controls were those without a herpes zoster diagnosis, matched by age groups and insurance plan. We selected 10 chronic conditions based on their prevalence in the general population. We calculated the attributable fraction and created a comorbidity composite score by summing the significant coefficient of regression of chronic conditions. We used logistic regression to evaluate the associations between herpes zoster and chronic conditions.

      Results

      We identified a total of 59,173 cases and 616,177 controls for the analysis. Risk of herpes zoster was significant for 8 of the 10 study conditions (odds ratios, 1.06-1.52). Herpes zoster risk also increased as a function of comorbidity composite score. The attributable fractions for these 8 significant conditions ranged from 0.24% to 2.89%.

      Conclusion

      The risk of herpes zoster may be increased in people with chronic conditions. However, this risk may not contribute substantially to the burden of herpes zoster in the population. The causes for most cases of herpes zoster remain unknown.

      Abbreviations and Acronyms:

      DM (diabetes mellitus), HZ (herpes zoster), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification)
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      References

        • Schmader K.
        Herpes zoster and postherpetic neuralgia in older adults.
        Clin Geriatr Med. 2007; 23: 615-632
        • Yawn B.P.
        • Saddier P.
        • Wollan P.C.
        • St Sauver J.L.
        • Kurland M.J.
        • Sy L.S.
        A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.
        Mayo Clin Proc. 2007; 82: 1341-1349
        • Leung J.
        • Harpaz R.
        • Molinari N.A.
        • Jumaan A.
        • Zhou F.
        Herpes zoster incidence among insured persons in the United States, 1993-2006: evaluation of impact of varicella vaccination.
        Clin Infect Dis. 2011; 52: 332-340
        • Donahue J.G.
        • Choo P.W.
        • Manson J.E.
        • Platt R.
        The incidence of herpes zoster.
        Arch Intern Med. 1995; 155: 1605-1609
        • Dworkin R.H.
        • Schmader K.E.
        Treatment and prevention of postherpetic neuralgia.
        Clin Infect Dis. 2003; 36: 877-882
        • Oxman M.N.
        • Levin M.J.
        • Johnson G.R.
        • et al.
        A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        N Engl J Med. 2005; 352: 2271-2284
        • Harpaz R.
        • Ortega-Sanchez I.R.
        • Seward J.F.
        • Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC)
        Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2008; 57: 1-30
        • Cohen J.I.
        • Brunell P.A.
        • Straus S.E.
        • Krause P.R.
        Recent advances in varicella-zoster virus infection.
        Ann Intern Med. 1999; 130: 922-932
        • Miller A.E.
        Selective decline in cellular immune response to varicella-zoster in the elderly.
        Neurology. 1980; 30: 582-587
        • Grote V.
        • von Kries R.
        • Rosenfeld E.
        • Belohradsky B.H.
        • Liese J.
        Immunocompetent children account for the majority of complications in childhood herpes zoster.
        J Infect Dis. 2007; 196: 1455-1458
        • Medco Health Solution, Inc. Medication Nation
        Research finds chronic health problems now afflict more than half of all Americans.
        (Accessed August 19, 2011)
        • Heymann A.D.
        • Chodick G.
        • Karpati T.
        • et al.
        Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel.
        Infection. 2008; 36: 226-230
        • Smitten A.L.
        • Choi H.K.
        • Hochberg M.C.
        • et al.
        The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom.
        Arthritis Rheum. 2007; 57: 1431-1438
        • Strangfeld A.
        • Listing J.
        • Herzer P.
        • et al.
        Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents.
        JAMA. 2009; 301: 737-744
        • Irwin M.
        • Costlow C.
        • Williams H.
        • et al.
        Cellular immunity to varicella-zoster virus in patients with major depression.
        J Infect Dis. 1998; 178: S104-S108
        • Livengood J.M.
        The role of stress in the development of herpes zoster and postherpetic neuralgia.
        Curr Rev Pain. 2000; 4: 7-11
        • Schmader K.
        • George L.K.
        • Burchett B.M.
        • Pieper C.F.
        Racial and psychosocial risk factors for herpes zoster in the elderly.
        J Infect Dis. 1998; 178: S67-S70
        • Dworkin R.H.
        • Banks S.M.
        A vulnerability-diathesis-stress model of chronic pain: herpes zoster and the development of postherpetic neuralgia.
        in: Gatchel R.J. Turk D.C. Psychological Factors in Pain: Critical Practices. Guilford Press, New York, NY1999: 247-269
        • Wolfe F.
        • Michaud K.
        • Chakravarty E.F.
        Rates and predictors of herpes zoster in patients with rheumatoid arthritis and non-inflammatory musculoskeletal disorders.
        Rheumatology (Oxford). 2006; 45: 1370-1375
        • Thompson Healthcare Inc
        MarketScan Databases User Guide and Database Dictionary, Commercial and Medicare Supplemental Databases, 2006 Edition.
        Thompson Healthcare Inc, Englewood, CO2007
        • Insinga R.P.
        • Itzler R.F.
        • Pellissier J.M.
        • Saddier P.
        • Nikas A.A.
        The incidence of herpes zoster in a United States administrative database.
        J Gen Intern Med. 2005; 20: 748-753
        • Thomson Healthcare
        Red Book: Pharmacy's Fundamental Reference.
        Thomson Reuters (Healthcare) Inc, Greenwood Village, CO2008
        • Deyo Y.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Rothman K.J.
        • Greenland S.
        • Lash T.L.
        Applications of Stratified Analysis Methods: Modern Epidemiology.
        in: 3rd ed. Lippincott Williams & Wilkins, Philadelphia, PA2008: 283-302
        • Levine B.
        What does the population attributable-fraction mean?.
        (Accessed July 19, 2010)
        • Lu P.J.
        • Euler G.L.
        • Jumaan A.O.
        • Harpaz R.
        Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors.
        Vaccine. 2009; 27: 882-887
        • Virnig B.A.
        • McBean M.
        Administrative data for public health surveillance and planning.
        Annu Rev Public Health. 2001; 22: 213-230
        • McDonald J.R.
        • Zeringue A.L.
        • Caplan L.
        • et al.
        Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis.
        Clin Infect Dis. 2009; 48: 1364-1371
        • Bearelly S.
        • Mruthyunjaya P.
        • Tzeng J.P.
        • et al.
        Identification of patients with diabetic macular edema from claims data: a validation study.
        Arch Ophthalmol. 2008; 126: 986-989
        • Kiyota Y.
        • Schneeweiss S.
        • Glynn R.J.
        • Cannuscio C.C.
        • Avorn J.
        • Solomon D.H.
        Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records.
        Am Heart J. 2004; 148: 99-104
        • Jumaan A.O.
        • Yu O.
        • Jackson L.A.
        • Bohlke K.
        • Galil K.
        • Seward J.F.
        Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002.
        J Infect Dis. 2005; 191: 2002-2007
        • Ahmed F.
        • Janes G.R.
        • Baron R.
        • Latts L.M.
        Preferred provider organization claims showed high predictive value but missed substantial proportion of adults with high-risk conditions.
        J Clin Epidemiol. 2005; 58: 624-628