1747. A Cohort Study of Risk Factors for Herpes Zoster in Men in Southern California
Session: Poster Abstract Session: Viral Infections; Pathogenesis and Epidemiology
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Poster__Tartof Sara_IDWEEK2013_SFran_9_24_2013_Final.pdf (428.9 kB)
  • Background: The risk factors for Herpes Zoster (HZ) remain controversial. While known risk factors include decline in cell mediated immunity (CMI), auto-immune, or inflammatory diseases, the immunosuppressed constitute a minority of HZ cases. This study assesses behavioral and clinical risk factors for HZ in a large cohort of sociodemographically diverse men.  

    Methods: The study population included men aged 45 to 69 years in 2000 who were members of the California Men’s Health Study, a large prospective cohort study which included members of the Kaiser Permanente Southern California (KPSC) health plan. Clinically diagnosed HZ cases were identified by ICD-9 code from KPSC inpatient, outpatient and emergency department files. Follow-up time began in 2002/2003 and ended at the time of HZ diagnosis, termination of KPSC membership, death, or June 30, 2012. Risk factors included disease comorbidities, healthcare utilization, demographic characteristics, lifestyle, and dietary factors. A Cox proportional hazards regression model was used for adjustment among covariates.

    Results: A total of 2166 cases of HZ were identified among 38,807 men with mean age 58.3 years (SD = 7.0). The overall cumulative risk at 5 and 10 years post-baseline was 3.2% (95% Confidence Interval (CI): 3.0, 3.4) and 7.8% (95% CI: 7.5, 8.2), respectively. In the final adjusted model, increasing age vs. < 55 years (all estimates presented as: Hazard Ratio (HR) [95% CI]), (55-59 years: 1.31 [1.15-1.49]; 60-64 years: 1.66 [1.46-1.88]; 65-69 years: 1.68 [1.48-1.91]), sedentary behavior (1.11 [1.01-1.21]), 3 or more outpatient visits in the year prior to baseline vs. 0 visits (3-9 visits: 1.40 [1.18-1.65], ≥10 visits: 1.69 [1.42- 2.02]), and CMI (Yes/No) (2.40 [1.87-3.08]) were significant risk factors for HZ. Alternatively, HZ vaccination (0.44 [0.36-0.53]), African-American race (0.64 [0.54-0.77], and current smoking (0.75 [0.63- 0.90]) were protective against HZ in the final model.  

    Conclusion: These data suggest that persons with high healthcare utilization and sedentary behavior may be at higher risk for HZ and therefore may be appropriate candidates for prioritization of vaccination.  Although similar to previous findings, the mechanism underlying the apparent association between smoking and HZ may need further investigation.

    Sara Tartof, PhD, MPH, Jeff Slezak, MS, Rulin Hechter, MD, PhD, Virgina Quinn, PhD, MPH, Steven Jacobsen, MD, PhD and Hung Fu Tseng, Ph.D., MPH, Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA


    S. Tartof, None

    J. Slezak, None

    R. Hechter, None

    V. Quinn, None

    S. Jacobsen, None

    H. F. Tseng, None

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