Reported Herpes Zoster Incidence Rates in Immunocompromised Adults Aged 18 Years or Older in England by Ethnicity and Socioeconomic Status: A Large Retrospective Cohort Study
Author(s)
Abda Mahmood, BSc (Hons), MSc, PhD1, Marie Libérée Nishimwe, MSc2, Alen Marijam, PharmD3, Yasmeeta Vekria, BSc(Hons)4, Susan Farrow, BMBCh MA (Oxon) FRCA DRCOG4, Manjit Hunjan, BA(Hons), MSC, PhD4, Desmond Curran, PhD1.
1GSK, Wavre, Belgium, 2GSK, Rueil-Malmaison, France, 3GSK, Munich, Germany, 4GSK, London, United Kingdom.
1GSK, Wavre, Belgium, 2GSK, Rueil-Malmaison, France, 3GSK, Munich, Germany, 4GSK, London, United Kingdom.
OBJECTIVES: This study aimed to examine herpes zoster (HZ) incidence according to ethnicity and socioeconomic status (SES) in immunocompromised (IC) adults.
METHODS: This retrospective cohort study analysed data from the United Kingdom Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics and Office for National Statistics. Adults ≥18 years with a record of at least one immunocompromising condition were identified from 2012-2018 and followed until 31-Dec-2019 (i.e: haematological malignancies, haematopoietic stem cell transplantation, solid organ transplant/malignancies, human immunodeficiency virus, and autoimmune diseases). Baseline data were extracted: age, sex, ethnicity and SES (least to most deprived [LstD; MstD]). HZ incidence rates (IRs) were estimated per 1,000 person-years (PYs) by ethnicity and SES (95% confidence intervals).
RESULTS: 1,764,900 IC adults were included (mean age [standard deviation [SD]: 57.70 [18.70] years; 55.78% female). Among those with ethnicity data reported (89.18%), 81.35%, 3.74%, and 2.27% were White, Asian, and Black, respectively. 17.69% of patients were reported as MstD and 21.54% as LstD. The highest reported HZ IRs were in White adults (8.17 [8.10-8.25]), and the lowest in Black adults (4.37 [4.05-4.70]). Furthermore, reported HZ IRs decreased as deprivation level increased (LstD: 8.16 [8.02-8.30], less deprived 7.93 [7.79-8.07], deprived 7.53 [7.39-7.68], more deprived 6.99 [6.86-7.14], MstD [6.62 [6.48-6.77]). However, index age varied between ethnic/SES groups, with White adults older than Black adults (mean [SD] age: 59.76 [18.41] vs. 53.26 [17.24] years) and LstD older than MstD (mean [SD] age: 59.81 [18.11] vs. 55.01 [18.99] years).
CONCLUSIONS: Interim results appear to conflict with general reports of higher disease risk in non-white individuals and those of lower SES. However, results are likely confounded by age, and factors like variations in prevalence of immunocompromising/chronic conditions. More data are expected to appropriately interpret and contextualise these results. Furthermore, reporting bias cannot be excluded given data reflect reported rather than all HZ cases.
METHODS: This retrospective cohort study analysed data from the United Kingdom Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics and Office for National Statistics. Adults ≥18 years with a record of at least one immunocompromising condition were identified from 2012-2018 and followed until 31-Dec-2019 (i.e: haematological malignancies, haematopoietic stem cell transplantation, solid organ transplant/malignancies, human immunodeficiency virus, and autoimmune diseases). Baseline data were extracted: age, sex, ethnicity and SES (least to most deprived [LstD; MstD]). HZ incidence rates (IRs) were estimated per 1,000 person-years (PYs) by ethnicity and SES (95% confidence intervals).
RESULTS: 1,764,900 IC adults were included (mean age [standard deviation [SD]: 57.70 [18.70] years; 55.78% female). Among those with ethnicity data reported (89.18%), 81.35%, 3.74%, and 2.27% were White, Asian, and Black, respectively. 17.69% of patients were reported as MstD and 21.54% as LstD. The highest reported HZ IRs were in White adults (8.17 [8.10-8.25]), and the lowest in Black adults (4.37 [4.05-4.70]). Furthermore, reported HZ IRs decreased as deprivation level increased (LstD: 8.16 [8.02-8.30], less deprived 7.93 [7.79-8.07], deprived 7.53 [7.39-7.68], more deprived 6.99 [6.86-7.14], MstD [6.62 [6.48-6.77]). However, index age varied between ethnic/SES groups, with White adults older than Black adults (mean [SD] age: 59.76 [18.41] vs. 53.26 [17.24] years) and LstD older than MstD (mean [SD] age: 59.81 [18.11] vs. 55.01 [18.99] years).
CONCLUSIONS: Interim results appear to conflict with general reports of higher disease risk in non-white individuals and those of lower SES. However, results are likely confounded by age, and factors like variations in prevalence of immunocompromising/chronic conditions. More data are expected to appropriately interpret and contextualise these results. Furthermore, reporting bias cannot be excluded given data reflect reported rather than all HZ cases.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH207
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Disease Classification & Coding, Public Health
Disease
Vaccines