Incidence of Herpes Zoster and Persistent Post-Zoster Pain in Adults With or Without Diabetes in the United States

Abstract

Abstract Background.  This study was designed to assess the association between diabetes and herpes zoster (HZ) and persistent post-zoster pain (PPZP). Methods.  We used a United States-based, 2005–2009 retrospective observational study of medical and pharmacy claims from adults in 3 large national databases. Incidence rate ratios were used to compare HZ incidence by diabetes status. Multivariate regressions assessed the age and sex-adjusted risk of diabetes on HZ and PPZP as a function of immune competence. National projections of HZ and PPZP cases were obtained. Results.  Among 51 million enrollees (∼88 million person-years [PYs] at risk), we identified 420 515 HZ cases. Patients with diabetes represented 8.7% of the PYs analyzed but accounted for 14.5% of the HZ cases and 20.3% of the PPZP cases. The crude incidence of HZ was 78% higher (7.96 vs 4.48 cases/1000 PY; P < .01) and the rate of PPZP was 50% higher (5.97% vs 3.93%; P < .01) in individuals with diabetes than without. Individuals with diabetes had 45% higher adjusted risk of HZ (hazard ratio [HR] = 1.45; 95% confidence intervals [CIs], 1.43–1.46) and 18% higher adjusted odds of PPZP (odds ratio = 1.18; 95% CI, 1.13–1.24). The risk of HZ associated with diabetes among immune-compromised individuals was weaker (HR = 1.10; 95% CI, 1.07–1.14) and the risk of PPZP was no longer significant. Every year, approximately 1.2 million HZ cases occur in US adults, 13% of these occur in individuals with diabetes. Conclusions.  Diabetes is a risk factor for HZ and PPZP in the US adult population. This association is stronger in immune-competent individuals.