Movahedi Mohammad, Cesta Angela, Li Xiuying, Tatangelo Mark Robert, Bombardier Claire
Toronto General Hospital Research Insitute, University Health Network, Toronto, Ontario, Canada.
Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2025 May 13;20(5):e0323229. doi: 10.1371/journal.pone.0323229. eCollection 2025.
Herpes zoster (HZ) infection is a significant concern among seniors and immunosuppressed patients including those with rheumatoid arthritis (RA). We aimed to compare healthcare utilization (HCU) and mortality in RA patients with and without HZ.
Patients from the Ontario Best Practices Research Initiative (OBRI) a clinical cohort (2008-2020) were linked to the Institute for Clinical Evaluative Sciences (ICES), a population health database. Each HZ patient was matched to four non-HZ patients based on sex, age, and HZ diagnosis date. The incidence of primary (HCU including hospitalization, Emergency Department (ED) visits, physician visits) and secondary (mortality and chronic clinical conditions) outcomes was calculated for each cohort, along with the impact of disease activity, patient-reported outcomes, and RA medication on these outcomes.
The study included 269 RA patients with and 1072 without HZ. At index date (HZ diagnosis) patients with HZ were less likely to have private health insurance (45.7% vs. 56.5%) and more prone to use biologics (30.9% vs. 26.8%) and JAK inhibitors (3.7% vs. 2.6%). Hospitalization/ED visits and mortality were higher in HZ patients, but these differences were not statistically significant after adjusting for other factors. HZ patients had significantly more physician visits (adj IRR: 1.17; 95% CI: 1.03-1.33). Female sex and lower CDAI were associated with fewer physician visits. JAK inhibitor use was associated with increased mortality (adj HR: 4.73, 95% CI: 1.68, 13.4).
HCU was higher in RA patients with HZ, particularly in physician visits. Disease activity, patient reported outcomes and RA medication used did not have an impact on HCU and mortality.
带状疱疹（HZ）感染是老年人和免疫抑制患者（包括类风湿关节炎（RA）患者）中的一个重要问题。我们旨在比较患有和未患有HZ的RA患者的医疗保健利用率（HCU）和死亡率。
来自安大略最佳实践研究倡议（OBRI）这一临床队列（2008 - 2020年）的患者与人口健康数据库临床评价科学研究所（ICES）进行了关联。根据性别、年龄和HZ诊断日期，将每位HZ患者与四名非HZ患者进行匹配。计算每个队列的主要（包括住院、急诊科就诊、医生就诊的HCU）和次要（死亡率和慢性临床病症）结局的发生率，以及疾病活动度、患者报告结局和RA药物对这些结局的影响。
该研究纳入了269例患有HZ的RA患者和1072例未患有HZ的RA患者。在索引日期（HZ诊断），患有HZ的患者拥有私人医疗保险的可能性较小（45.7%对56.5%），更倾向于使用生物制剂（30.9%对26.8%）和JAK抑制剂（3.7%对2.6%）。HZ患者的住院/急诊科就诊率和死亡率较高，但在调整其他因素后，这些差异无统计学意义。HZ患者的医生就诊次数显著更多（调整后的发病率比：1.17；95%置信区间：1.03 - 1.33）。女性和较低的疾病活动指数（CDAI）与较少的医生就诊次数相关。使用JAK抑制剂与死亡率增加相关（调整后的风险比：4.73，95%置信区间：1.68，13.4）。
患有HZ的RA患者的HCU较高，尤其是在医生就诊方面。疾病活动度、患者报告结局和所使用的RA药物对HCU和死亡率没有影响。
