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Introduction <p>This study aims to deliver contemporary, population-based estimates of herpes zoster (HZ) incidence, temporal trends, complications, healthcare utilisation and direct costs among general adults and adults with increased-risk conditions.</p> Methods <p>A retrospective cohort study using the Yinzhou Integrated Health Platform (2015–2021; China) was performed. Incident HZ was ascertained after a 1-year washout; increased-risk conditions were pre-specified (immunocompromising/autoimmune). We calculated age-/sex-standardised incidence, assessed trends with joinpoint regression and summarised HZ-related outpatient visits, hospitalisations and direct medical costs [Chinese yuan (¥) and US dollars ($)].</p> Results <p>Among 5.42 million person-years, including 790,410 subjects, 25,855 incident HZ events were identified. Overall incidence was 4.77/1000 person-years (PY) [95% confidence interval (CI) 4.71–4.83] and 16.13/1000 PY (95% CI 15.25–17.06) in increased-risk adults [incidence rate ratio (IRR) 3.44 versus in adults without immunocompromising conditions or autoimmune diseases (AIDs)]. Incidence rose with age (peak 70–79&#xa0;years overall; 60–69&#xa0;years increased-risk) and was higher in women. Postherpetic neuralgia (PHN) was the most frequent complication (8.96% overall; 10.88% increased-risk). Standardised incidence increased from 4.67 to 7.51/1000 PY during 2015–2021 [annual percentage change (APC) 7.94%], with a steep rise to 2019 and plateau thereafter. Hospitalisation among incident HZ was 1.35%. Mean direct cost per episode was Chinese yuan (¥)625.52 [US dollars ($)94.35] for outpatients and ¥8854.03 ($1335.45) for inpatients; increased-risk outpatients incurred higher mean costs (¥1205.47, $181.82). Across strata, complications – especially PHN – were associated with more visits and higher expenditure.</p> Conclusions <p>HZ imposes a rising, age- and risk-concentrated burden in Chinese adults, with PHN being the principal driver of resource use and costs. These real-world estimates support prioritising zoster vaccination for adults ≥ 50&#xa0;years and clinically vulnerable groups, and integrating HZ surveillance and management within chronic-disease programmes.</p>

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Rising Burden of Herpes Zoster among General Adults and Increased-Risk Groups in Eastern China, 2015–2021: A Population-Based Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月4日

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  • Zhenwei Li,
  • Shenjia Gu,
  • Jiajun Li,
  • Guomin Zhang,
  • Zheng Wu,
  • Hongbo Lin,
  • Kan Chen,
  • Zhexin Xu,
  • Chuanxi Fu

摘要

Introduction

This study aims to deliver contemporary, population-based estimates of herpes zoster (HZ) incidence, temporal trends, complications, healthcare utilisation and direct costs among general adults and adults with increased-risk conditions.

Methods

A retrospective cohort study using the Yinzhou Integrated Health Platform (2015–2021; China) was performed. Incident HZ was ascertained after a 1-year washout; increased-risk conditions were pre-specified (immunocompromising/autoimmune). We calculated age-/sex-standardised incidence, assessed trends with joinpoint regression and summarised HZ-related outpatient visits, hospitalisations and direct medical costs [Chinese yuan (¥) and US dollars ($)].

Results

Among 5.42 million person-years, including 790,410 subjects, 25,855 incident HZ events were identified. Overall incidence was 4.77/1000 person-years (PY) [95% confidence interval (CI) 4.71–4.83] and 16.13/1000 PY (95% CI 15.25–17.06) in increased-risk adults [incidence rate ratio (IRR) 3.44 versus in adults without immunocompromising conditions or autoimmune diseases (AIDs)]. Incidence rose with age (peak 70–79 years overall; 60–69 years increased-risk) and was higher in women. Postherpetic neuralgia (PHN) was the most frequent complication (8.96% overall; 10.88% increased-risk). Standardised incidence increased from 4.67 to 7.51/1000 PY during 2015–2021 [annual percentage change (APC) 7.94%], with a steep rise to 2019 and plateau thereafter. Hospitalisation among incident HZ was 1.35%. Mean direct cost per episode was Chinese yuan (¥)625.52 [US dollars ($)94.35] for outpatients and ¥8854.03 ($1335.45) for inpatients; increased-risk outpatients incurred higher mean costs (¥1205.47, $181.82). Across strata, complications – especially PHN – were associated with more visits and higher expenditure.

Conclusions

HZ imposes a rising, age- and risk-concentrated burden in Chinese adults, with PHN being the principal driver of resource use and costs. These real-world estimates support prioritising zoster vaccination for adults ≥ 50 years and clinically vulnerable groups, and integrating HZ surveillance and management within chronic-disease programmes.