title: Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a prospective cohort study.
abstract: We analysed data from a prospective cohort of 255,024 adults aged ⩾45 years recruited from 2006-2009 to identify characteristics associated with a zoster diagnosis. Diagnoses were identified by linkage to pharmaceutical treatment and hospitalization records specific for zoster and hazard ratios were estimated. Over 940,583 person-years, 7771 participants had a zoster diagnosis; 253 (3·3%) were hospitalized. After adjusting for age and other factors, characteristics associated with zoster diagnoses included: having a recent immunosuppressive condition [adjusted hazard ratio (aHR) 1·58, 95% confidence interval (CI) 1·32-1·88], female sex (aHR 1·36, 95% CI 1·30-1·43), recent cancer diagnosis (aHR 1·35, 95% CI 1·24-1·46), and severe physical limitation vs. none (aHR 1·33, 95% CI 1·23-1·43). The relative risk of hospitalization for zoster was higher for those with an immunosuppressive condition (aHR 3·78, 95% CI 2·18-6·55), those with cancer (aHR 1·78, 95% CI 1·24-2·56) or with severe physical limitations (aHR 2·50, 95% CI 1·56-4·01). The novel finding of an increased risk of zoster diagnoses and hospitalizations in those with physical limitations should prompt evaluation of the use of zoster vaccine in this population.
authors.affiliation: School of Public Health and Community Medicine, UNSW,Sydney,NSW,Australia.
authors.forename: B
authors.initials: B
authors.lastname: Liu
authors.affiliation: School of Public Health and Community Medicine, UNSW,Sydney,NSW,Australia.
authors.forename: A E
authors.initials: AE
authors.lastname: Heywood
authors.affiliation: The Kirby Institute, UNSW,Sydney,NSW,Australia.
authors.forename: J
authors.initials: J
authors.lastname: Reekie
authors.affiliation: The Sax Institute,Sydney,NSW,Australia.
authors.forename: E
authors.initials: E
authors.lastname: Banks
authors.affiliation: The Kirby Institute, UNSW,Sydney,NSW,Australia.
authors.forename: J M
authors.initials: JM
authors.lastname: Kaldor
authors.affiliation: National Centre for Immunisation Research and Surveillance,University of Sydney,NSW,Australia.
authors.forename: P
authors.initials: P
authors.lastname: McIntyre
authors.affiliation: School of Public Health and Community Medicine, UNSW,Sydney,NSW,Australia.
authors.forename: A T
authors.initials: AT
authors.lastname: Newall
authors.affiliation: School of Public Health and Community Medicine, UNSW,Sydney,NSW,Australia.
authors.forename: C R
authors.initials: CR
authors.lastname: Macintyre
mesh_terms: D000368:Aged; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
keywords: Herpes zoster; prospective study; risk factors; shingles; vaccination