Quantifying the incidence and burden of herpes zoster in New Zealand general practice: a retrospective cohort study using a natural language processing software inference algorithm

Abstract

Objective: To investigate the incidence of primary care presentations for herpes zoster (zoster) in a representative New Zealand population and to evaluate the utilisation of primary healthcare services following zoster diagnosis.

Design: A cross-sectional retrospective cohort study used a natural language processing software inference algorithm to identify general practice consultations for zoster by interrogating 22 million electronic medical record (EMR) transactions routinely recorded from January 2005 to December 2015. Data linking enabled analysis of the demographics of each case. The frequency of doctor visits was assessed prior to and after the first consultation diagnosing zoster to determine health service utilisation.

Setting: General practice, using EMRs from two primary health organisations located in the lower North Island, New Zealand.

Participants: Thirty-nine general practices consented interrogation of their EMRs to access deidentified records for all enrolled patients. Out-of-hours and practice nurse consultations were excluded.

Main outcome measures: The incidence of first and repeated zoster-related visits to the doctor across all age groups and associated patient demographics. To determine whether zoster affects workload in general practice.

Results: Overall, for 6 189 019 doctor consultations, the incidence of zoster was 48.6 per 10 000 patient-years (95% CI 47.6 to 49.6). Incidence increased from the age of 50 years to a peak rate of 128 per 10 000 in the age group of 80-90 years and was significantly higher in females than males (p<0.001). Over this 11-year period, incidence increased gradually, notably in those aged 80-85 years. Only 19% of patients had one or more follow-up zoster consultations within 12 months of a zoster index consultation. The frequency of consultations, for any reason, did not change between periods before and after the diagnosis.

Conclusions: Zoster consultations in general practice are rare, and the burden of these cases on overall general practice caseload is low.

Keywords: health informatics; herpes zoster; primary care; virology.

Figure 1

Recruitment process. HZ - Herpes zoster; NHI - National Health Index.

Figure 2

Herpes zoster index consultation rate by age group (bars represent 95% CIs).

Figure 3

Herpes zoster index consultation rate over time from age of 50 years, by 5-year age groups (n is mean patient-years per year, with 95% CIs and linear regression shown in blue).

Figure 4

Herpes zoster consultation rate of index case over time by gender, age adjusted (95% CIs). F, female; M, male.

Figure 5

Proportion of herpes zoster consultations with or without follow-up visits by age group showing 95% CIs.

Figure 6

Distribution of overall consultation visits occurring prior to and after a herpes zoster index case by age group.