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Nakul Shekhawat, Nidhi Talwar, Joshua D Stein; Demographic and temporal variation in incidence of herpes zoster ophthalmicus in the United States population. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4257.
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© ARVO (1962-2015); The Authors (2016-present)
The epidemiology of herpes zoster ophthalmicus (HZO) is thought to be changing but is not well understood. We sought to evaluate the incidence of HZO and how this varies by demographic and temporal factors.
We analyzed health claims data for 21 million patients enrolled in a large nationwide managed care plan from 2001-2016. To be eligible, enrollees must have been continuously enrolled in the health plan for 3 years with no record of HZO during that timeframe (to exclude persons with pre-existing disease). After this lookback period, patients were followed longitudinally over time and observed for incident HZO. Patients were censored at the time they were first diagnosed with HZO, when they left the plan, or at the end of follow-up (2016). Incident cases were defined as persons with new ICD-9 or ICD-10 codes for HZO (ICD-9 053.20-22, &/or 053.29; ICD-10 B02.30-34, &/or B02.39) followed by at least one subsequent record of HZO on a different date to confirm presence of this condition. Incidence rates per 100,000 person-years of observation were calculated yearly and also compared by age at beginning of follow-up, birth year, sex, and race. Differences across groups were assessed via an incidence rate ratio test.
Incidence rates of HZO increased 2.4-fold from 2004 to 2016, increasing from 8.10 cases/100,000 person-years in 2004 to 19.5/100,000 person-years in 2016 (p<0.05; Figure 1). HZO incidence increased with age, with the lowest incidence among patients age <15 years (3.5/100,000 person-years) and highest incidence among patients age 75 years or older (72.9/100,000 person-years, p<0.05; Table 1). Females had a higher incidence of HZO than males (42.2/100,000 person-years vs. 37.2/100,000 person-years, p<0.05). Incidence rates per 100,000 person-years were highest among whites (39.1) and lower among blacks (31.1), Asians (27.3), and Latinos (19.2, p<0.05 for all).
This study noted a substantial increase in nationwide incidence of HZO from 2004-2016, raising concern that the epidemiology of HZO may be evolving due to chickenpox vaccination. Incidence of HZO increased with patient age, highlighting the public health importance of timely shingles vaccination for older age groups. Females and white patients had higher incidence, but whether this is due to differences in community exposure or biological mechanisms remains to be explored.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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