Jackson Lisa A, Reynolds Meredith A, Harpaz Rafael
Group Health Center for Health Studies, Seattle, Washington 98101, USA.
Clin Infect Dis. 2008 Sep 15;47(6):754-9. doi: 10.1086/591132.
The availability of a vaccine for the prevention of herpes zoster has increased interest in methods to measure zoster disease burden. Hospitalizations assigned a zoster diagnosis code have been used as indicators of severe zoster in prior studies. However, a zoster diagnosis code may not be a specific indicator of severe zoster illness, because the code may be assigned to a hospitalization for another cause in a person with coincident zoster.
To assess the validity of a hospital diagnosis code of zoster as an indicator of hospitalizations that are attributable to zoster, we identified all hospitalizations with a zoster diagnosis code assigned in any position among members of a managed-care organization who were >or=50 years of age during 1992-2004. Of those, we selected a sample of 260 hospitalizations for chart review.
Chart reviews were completed for 225 hospitalizations. Sixty-five (29%) were because of zoster or a complication of zoster treatment, and an additional 9 (4%) were because of postherpetic neuralgia or a complication of postherpetic neuralgia treatment. Although the overall age-adjusted rate of hospitalizations with a zoster diagnosis code was 42.5 hospitalizations per 100,000 population per year, the estimated rate of hospitalizations because of zoster, postherpetic neuralgia, or adverse effects of a medication used to treat zoster or postherpetic neuralgia was only 14.0 hospitalizations per 100,000 population per year.
Rates of hospitalizations associated with a zoster diagnosis code will substantially overestimate the burden of hospitalizations attributable to zoster in older adults.
预防带状疱疹疫苗的出现使得人们对衡量带状疱疹疾病负担的方法更感兴趣。在先前的研究中，被分配带状疱疹诊断代码的住院病例被用作严重带状疱疹的指标。然而，带状疱疹诊断代码可能并非严重带状疱疹疾病的特异性指标，因为该代码可能被分配给患有带状疱疹的人因其他原因导致的住院病例。
为评估带状疱疹医院诊断代码作为带状疱疹所致住院病例指标的有效性，我们确定了1992年至2004年期间管理式医疗组织中年龄≥50岁成员中任何位置被分配带状疱疹诊断代码的所有住院病例。在这些病例中，我们选取了260例住院病例进行病历审查。
完成了225例住院病例的病历审查。其中65例（29%）是由于带状疱疹或带状疱疹治疗并发症，另外9例（4%）是由于带状疱疹后神经痛或带状疱疹后神经痛治疗并发症。尽管每年每10万人口中被分配带状疱疹诊断代码的住院病例的总体年龄调整率为42.5例，但因带状疱疹、带状疱疹后神经痛或用于治疗带状疱疹或带状疱疹后神经痛的药物不良反应导致的住院病例估计率仅为每年每10万人口14.0例。
与带状疱疹诊断代码相关的住院率将大幅高估老年人中带状疱疹所致住院的负担。
