Abstract
This study, from a team working at the London School of Hygiene and Tropical Medicine in the UK, investigated a large group of patients aged 65 or over, seeing a GP between 2003 and 2013 who had experienced an attack of shingles (herpes zoster) during this period. The source of the information was an anonymised data base known as the Clinical Practice Research Data link which records information from many general practices in England. The data was obtained before the introduction of the zoster (shingles) vaccine in the UK. Amongst over 37,000 patients with shingles there was a higher rate of infection in those living in care homes, in females and in non‐migrants or in those with white ethnicity as well as those living alone. There were slightly fewer cases of shingles in those living in deprived circumstances. Although patients taking treatments that reduced the overall level of immunity were more likely to develop shingles, diabetic patients were not. The authors suggest that it might be helpful to promote immunization in some of these groups, such as those living in care homes.
Highlights
Zoster vaccination was introduced in England in 2013, where tackling health inequalities is a statutory requirement
Mediating variables made little difference to the adjusted rate ratios (ARRs) of social factors but were themselves associated with increased zoster burden (ARR varied from 1Á11 to 3Á84)
The demographic characteristics of patients with and without a prior zoster history are presented in Appendix S7. Those with a previous history of zoster were likely to be older at the start of the study (1 September 2003), women, nonimmigrants and individuals of white ethnicity, but were similar to included individuals with respect to Index of Multiple Deprivation (IMD) quintiles
Summary
To evaluate health inequalities in zoster disease burden prior to zoster vaccine introduction in England. Methods This population-based cohort study used anonymized U.K. primary care data linked to hospitalization and deprivation data. Poisson regression was used to obtain adjusted rate ratios (ARRs) for the association of sociodemographic factors (ethnicity, immigration status, individuals’ area-level deprivation, care home residence, living arrangements) with first zoster episode. Zoster incidence decreased slightly with increasing deprivation (ARR most vs least deprived 0Á96 (95% CI 0Á92–0Á99) and among those living alone (ARR 0Á96, 95% CI 0Á94–0Á98). Mediating variables made little difference to the ARR of social factors but were themselves associated with increased zoster burden (ARR varied from 1Á11 to 3Á84). Further study is needed to ascertain whether these individuals are attending for zoster vaccination
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