Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007–2018

Abstract

Introduction Several chronic underlying conditions (UCs) are known to be risk factors for developing herpes zoster (HZ) and to increase the severity of HZ and its risk of recurrence. The aim of this study was to investigate the incidence and recurrence of HZ in adult patients with one or multiple UCs. Methods A retrospective cohort study based on claims data representing 13% of the statutory health insurance population from 2007 to 2018 in Germany was performed. Patients aged ≥ 18 years were included when at least one of the following UCs was diagnosed: asthma, chronic heart failure, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), depression, diabetes mellitus type 1 or 2, and rheumatoid arthritis (RA). Exact matching was used to account for differences in the distribution of age and sex between the case and matched control cohorts. Multi-morbidity was considered in sensitivity analyses by analyzing patients with only one UC. Results Patients with asthma, CHD, COPD, depression, and RA had, on average, a 30% increased risk of developing acute HZ compared to patients without any UC. RA was found to have the highest odds ratio among these conditions, varying from 1.37 to 1.57 for all age groups. Patients with depression also showed a high risk of developing HZ. Analysis of recurrence indicated that patients with at least one UC in the age groups 18–49 years and 50–59 years had the highest risk for a recurrent HZ. After experiencing a first recurrence, patients, regardless of age group, had a two- to threefold higher risk for a second recurrence. Conclusion This study of representative claims data shows a higher HZ incidence and recurrence frequency in patients with UCs. These results provide relevant information for national health care guidelines and disease management programs. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00535-7.

Association between vitamin D and incident herpes zoster: a UK Biobank study

“…We defined herpes zoster using EHR, but people with more comorbidities may visit their primary care physicians more frequently. Thus, herpes zoster among these people is more likely to be diagnosed, while mild shingles among a younger or healthier population might not be noticed (22). In our study population, although the proportions of people with diabetes and chronic obstructive pulmonary disease were slightly higher in the vitamin D deficiency group, the overall distributions of comorbidities and immunosuppression were similar across different vitamin D statuses.…”

“…HZ was defined using EHRs, but people with a greater number of comorbidities may visit their primary care physicians more frequently than people without underlying chronic diseases; as such, HZ in these people is more likely to be diagnosed, whereas mild shingles among a younger or healthier population might not be noticed. 23 In the study population, although the proportions of people with certain conditions were slightly higher in those who were deficient in vitamin D, the overall distributions of comorbidities and immunosuppression were similar across different vitamin D statuses. Any ascertainment bias in the study presented here should be non-differential.…”

Association of asthma and herpes zoster, the role of vaccination: A literature review

“…There are conflicting findings regarding the use of steroids in asthma patients and their association with HZ development. Several studies have found that when compared to those who did not have a regular controller, asthma patients who received daily inhaled corticosteroid (ICS) or systematic corticosteroid treatment had a slightly higher risk of HZ 25,26,29,32 . The same results were obtained when a noncorticosteroid immunosuppressive agent was used 26 .…”

“…21,22 Based on these observations, several studies have reported an increased susceptibility to viral infections, including in nonrespiratory sites, in asthmatic patients. 19,23 4 | ASTHMA AND HZ Association between asthma and skin infection, specifically HZ, has been proposed in several studies, both in the adult [24][25][26][27][28][29] and pediatric [30][31][32] populations. In the adult populations, the prevalence of HZ sufferers who had a history of bronchial asthma ranges from 7.1% to 23% 24,26 while, in the pediatric population is around 7.7% to 28.1%.…”

“…Association between asthma and skin infection, specifically HZ, has been proposed in several studies, both in the adult 24–29 and pediatric 30–32 populations. In the adult populations, the prevalence of HZ sufferers who had a history of bronchial asthma ranges from 7.1% to 23% 24,26 while, in the pediatric population is around 7.7% to 28.1%.…”