Age-Specific Risk of Herpes Zoster in Adults Aged ≥18 Years With Comorbid Conditions-A Retrospective Cohort Study in the United States.

Abstract

Older (≥50 years of age [YoA]) and immunocompromised adults are at higher risk of herpes zoster (HZ). Those with comorbidities are also at increased risk, however, recent US evidence is lacking, especially among 18-49 YoA. This US retrospective cohort study (2015-2022, Merative MarketScan Commercial and Medicare Supplemental) compared HZ incidence rates (IRs) in younger immunocompetent adults (18-49 YoA) with comorbidities (asthma, chronic kidney disease [CKD], chronic obstructive pulmonary disease [COPD], depression, diabetes, stress, and trauma) versus immunocompetent adults 50-59 YoA without comorbidities. Adjusted HZ IR ratios (aIRRs) versus 50-59 YoA adults were compared using a predetermined 0.62 non-inferiority margin for the aIRR 95% confidence interval lower limit (95% CI LL). aIRRs were classified as comparable (aIRR 95% CI LL > 0.62 and ≤1.0), significantly higher (aIRR 95% CI LL > 1.0), or inconclusive (any other result). HZ case: diagnostic code B02.2x plus oral antiviral ±7 days. Sensitivity analyses investigated HZ IRs by number of comorbid conditions (1, 2, or ≥3). HZ IRs were significantly higher (aIRR 95% CI LL > 1.0) from 30 to 39 YoA (aIRR; 95% CI) in asthma (1.19; 1.10-1.29), COPD (1.31; 1.22-1.40), depression (1.31; 1.22-1.40), diabetes (1.18; 1.06-1.32), stress (1.28; 1.11-1.47), and trauma (1.25; 1.17-1.34) populations than immunocompetent 50-59 YoA and from 50 to 59 YoA in CKD (1.50; 1.28-1.77). In sensitivity analyses, HZ IR appeared to increase with more comorbid conditions and age. The study found that younger adults (30+ YoA) with certain comorbidities have a higher HZ risk than immunocompetent 50-59 YoA adults.