Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Curr Med Res Opin. 2024 Nov;40(11):1885-1891. doi: 10.1080/03007995.2024.2408465. Epub 2024 Oct 15.
Infectious mononucleosis (IM) or mono is typically caused by primary infection with Epstein-Barr virus (EBV) and may have a months-long, complicated course. We utilized population-based data to add to the limited literature on health care utilization following EBV infection.
The Rochester Epidemiology Project includes medical records for ∼60% of residents living in 27 counties of Minnesota (MN) and Wisconsin (WI). Persons meeting a case definition of recent EBV infection from 1 January 1998 to 31 December 2021 were compared to three persons not meeting the definition, matched on case's sex, age, and index date. Emergency department (ED) visits and hospitalizations in the two groups were compared during 5-years' follow-up divided into three periods (short-term ≤3 months, mid-term >3 months-1 year, long-term >1-5 years). Adjusted hazard ratios (AHR) were estimated to account for the potential influence of confounding variables.
In total, 6,423 persons had a recent EBV infection and were matched to 19,269 comparators. The risk of an ED visit was significantly higher among cases in the short-term period (24.3% vs referents: 7.6%, <.001; AHR = 3.71, 95% CI = 3.41-4.03). Cases also had an increased risk of hospitalization in the short-term (5.2% vs 1.6%: referents, <.001; AHR = 3.53, 95% CI = 2.94-4.24). For ED visits but not hospitalization, the excess risk persisted into the mid-term follow-up period. Persons without a concurrent clinical diagnosis of IM continued to have an increased risk of hospitalizations up to 1 year after index date (AHR = 1.45, 95% CI = 1.09-1.91) and an increased risk of ED visits up to 5 years after the index date (AHR = 1.29, 95% CI = 1.14-1.46).
There is a substantial short- and mid-term increased risk of serious health care encounters associated with recent EBV infection. Mid- and long-term risks are increased in patients who do not have a concomitant diagnosis of IM.
传染性单核细胞增多症（IM）或单核细胞增多症通常由 EBV 原发性感染引起，其病程可能长达数月且复杂。我们利用基于人群的数据，对 EBV 感染后的医疗保健利用情况进行了有限的文献补充。
罗切斯特流行病学项目（Rochester Epidemiology Project）包括明尼苏达州（MN）和威斯康星州（WI）27 个县约 60%居民的医疗记录。从 1998 年 1 月 1 日至 2021 年 12 月 31 日，满足 EBV 近期感染病例定义的患者与 3 名未满足该定义的患者进行了比较，匹配病例的性别、年龄和索引日期。在 5 年的随访期间，将两组患者分为三个时间段（短期≤3 个月、中期>3 个月-1 年、长期>1-5 年），比较急诊就诊和住院情况。为了考虑混杂变量的潜在影响，估计了调整后的风险比（AHR）。
共有 6423 人最近发生了 EBV 感染，并与 19269 名对照进行了匹配。在短期随访中，病例组急诊就诊的风险显著高于对照组（24.3%对参照组：7.6%，<0.001；AHR=3.71，95%CI=3.41-4.03）。病例组在短期随访中也有更高的住院风险（5.2%对参照组：1.6%，<0.001；AHR=3.53，95%CI=2.94-4.24）。对于急诊就诊，但不是住院治疗，这种超额风险在中期随访期间仍然存在。没有同时诊断为 IM 的患者在指数日期后 1 年内仍有更高的住院风险（AHR=1.45，95%CI=1.09-1.91），在指数日期后 5 年内仍有更高的急诊就诊风险（AHR=1.29，95%CI=1.14-1.46）。
近期 EBV 感染与短期和中期严重医疗保健就诊风险显著增加有关。在没有并发 IM 诊断的患者中，中、长期风险增加。
