Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm

Abstract

ObjectiveTo investigate the incidence of primary care presentations for herpes zoster (zoster) in a representative New Zealand population and to evaluate the utilisation of primary healthcare services following zoster diagnosis.DesignA cross-sectional retrospective cohort study used a natural language processing software inference algorithm to identify general practice consultations for zoster by interrogating 22 million electronic medical record (EMR) transactions routinely recorded from January 2005 to December 2015. Data linking enabled analysis of the demographics of each case. The frequency of doctor visits was assessed prior to and after the first consultation diagnosing zoster to determine health service utilisation.SettingGeneral practice, using EMRs from two primary health organisations located in the lower North Island, New Zealand.ParticipantsThirty-nine general practices consented interrogation of their EMRs to access deidentified records for all enrolled patients. Out-of-hours and practice nurse consultations were excluded.Main outcome measuresThe incidence of first and repeated zoster-related visits to the doctor across all age groups and associated patient demographics. To determine whether zoster affects workload in general practice.ResultsOverall, for 6 189 019 doctor consultations, the incidence of zoster was 48.6 per 10 000 patient-years (95% CI 47.6 to 49.6). Incidence increased from the age of 50 years to a peak rate of 128 per 10 000 in the age group of 80–90 years and was significantly higher in females than males (p<0.001). Over this 11-year period, incidence increased gradually, notably in those aged 80–85 years. Only 19% of patients had one or more follow-up zoster consultations within 12 months of a zoster index consultation. The frequency of consultations, for any reason, did not change between periods before and after the diagnosis.ConclusionsZoster consultations in general practice are rare, and the burden of these cases on overall general practice caseload is low.

A systematic literature review of herpes zoster incidence worldwide

“… 54 Except for one Japanese study that did not report the incidence for persons ≥75 YOA 45 and one Chinese study, 66 all Asian studies reported a drop in incidence for the highest age groups. 47 , 48 , 59 , 61 , 62 , 67 , 82 Furthermore, 2 Italian studies, 69 , 71 2 Spanish studies, 56 , 57 one UK study 37 and one study from New Zealand 75 reported a decline in the incidence for the highest age groups. From the other European countries, Australia, Canada and the USA, no studies were found that solely reported a declining incidence in the highest age groups.…”

“…The characteristics of the 69 individual studies are provided in Table 1 . The majority of studies were conducted in the United States of America (USA; n = 14), 6 , 15–27 followed by Canada (n = 6), 28–33 the United Kingdom (UK; n = 6), 34–39 Germany (n = 5), 40–44 Japan (n = 5), 45–49 the Netherlands (n = 5), 36 , 50–53 Spain (n=5), 54–58 Taiwan (n = 4), 59–62 Australia (n = 3), 63–65 China (n = 3), 66–68 Italy (n = 3), 69–71 France (n = 2), 72 , 73 New Zealand(n = 2), 74 , 75 Sweden (n = 2), 76 , 77 Denmark (n = 1), 78 Israel (n = 1), 79 Norway (n = 1), 80 Poland (n = 1), 81 and South Korea (n = 1). 82 One study presented data for both the Netherlands and the UK separately; 36 this study is captured within the individual countries Figure 2 ; Table 1 .…”

“…However, in 14 studies a drop in incidence was reported for the highest age groups, i.e., ≥70 YOA, 67 , 82 ≥75 YOA, 56 ≥80 YOA, 42 , 47 , 48 , 57 , 61 , 71 or ≥85 YOA. 37 , 62 , 69 , 75 , 79 In 8 studies, both scenarios (i.e. increasing incidence with increasing age and a decline in incidence for the highest age group) were reported during different time periods.…”

Herpes zoster in older adults in Ontario, 2002–2016: Investigating incidence and exploring equity

“…There is conflicting evidence regarding SES (i.e. income, deprivation) and HZ incidence, with some reporting no association, some reporting an increased risk in more deprived individuals and others reporting an inverse association [2,[37][38][39]. In…”

Perfil clínico das internações por herpes zoster em um hospital universitário

“…1,2 Constitui-se como doença infecciosa comum, dado que em média um terço da população já apresentou o quadro, sendo a incidência maior em faixas etárias avançadas, visto que há um declínio na imunidade celular com o passar do tempo. 3 A doença pode evoluir para a cura em poucas semanas ou a dor pode continuar por meses ou anos. 4,5 A persistência da dor após a cura da erupção é a complicação mais frequente, sendo denominada de neuralgia pós-herpética (NPH).…”