Investigating the association between cataract patients and the risk of herpes zoster in a cohort study

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Methods A cohort of cataract patients, aged 20–84 years, was assembled from electronic health records of Taiwan National Health Insurance Program spanning a period of eight years (2013–2020). A non-cataract group matched for sex, age, and comorbidities was also identified from the same database. The incidence rate of herpes zoster within the follow-up period was calculated between the two groups. The risk of herpes zoster was compared between the two groups using a Cox proportional hazards model, adjusting for potential confounders. Results The study included 1,299,685 individuals in the cataract group. The mean age was 64 years old and about 43.9% of study subjects were male. The non-cataract group had similar numbers of study subjects and comparable distributions in terms of sex and age. The incidence rate of herpes zoster was 10.84 per 1000 person-years in the cataract group and 6.36 per 1000 person-years in the non-cataract group (incidence rate ratio = 1.71, 95% CI = 1.69–1.72). After adjusting for potential confounders, the hazard ratio was 1.71 for herpes zoster in individuals with cataract when compared to those without cataract (95%CI = 1.69–1.73). Conclusion Our cohort study reveals that cataract patients are at an increased risk of developing herpes zoster. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination. cataract cohort study herpes zoster Taiwan WHAT IS KNOWN 1. Cataract and herpes zoster are indeed prevalent conditions among the aging population and represent significant public health challenges worldwide due to their high prevalence, associated morbidity, and healthcare burden. WHAT IS NEW HERE : 1. After adjusting for potential confounders, the hazard ratio was 1.71 for herpes zoster in individuals with cataract when compared to those without cataract (95%CI = 1.69-1.73). TRANSLATIONAL IMPACT: 1. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination. INTRODUCTION Cataract and herpes zoster are indeed prevalent conditions among the aging population and represent significant public health challenges worldwide due to their high prevalence, associated morbidity, and healthcare burden. Cataract is characterized by the progressive clouding of the lens that is associated with decreased visual acuity. Cataract is still the leading cause of blindness and affects approximately 95 million people globally.( 1 , 2 ) The prevalence of cataract increases markedly with age, with a higher prevalence observed in older age groups. For example, in a meta-analysis conducted by Hashemi et al, the overall prevalence of cataract was 3.01% in ages 20–39, 16.97% in ages 40–59, and 54.38% in ages 60 or older, respectively.( 3 ) This is consistent with the well-established understanding that aging is a risk factor for the development of cataract. Herpes zoster results from the reactivation of the varicella-zoster virus (VZV), which remains dormant in the sensory nerve ganglia after primary infection with varicella (chickenpox).( 4 , 5 ) Herpes zoster causes painful manifestations and subsequent impairment in quality of life, so it is a major health burden. The reactivation of VZV typically occurs later in life or occurs in other conditions that compromise the immune system.( 6 – 8 ) While cell-mediated immunity to varicella-zoster virus declines with age, the risk of developing herpes zoster increases with age, especially after age 50.( 9 – 11 ) This decline in immunity is thought to be one of the key factors contributing to the increased risk of developing herpes zoster, especially in older adults. For example, the cumulative incidence of herpes zoster for people aged 50–59 years was 3.59 per 1000 person-years and peaked at 9.94 per 1000 person-years for people aged ≥ 80 years in a population-based study conducted by Södergren et al in Sweden.( 12 ) While both conditions share some risk factors, such as aging and impaired immune status,( 3 , 12 – 14 ) the relationship between cataract and herpes zoster remains unexplored. Understanding the potential link between cataract and herpes zoster is of importance from both public health and clinical perspectives. Elucidating this association could provide preventive strategies aimed at reducing the burden of herpes zoster among cataract patients, particularly through targeted vaccination. Therefore, the present cohort study aimed to fill this knowledge gap by systematically investigating whether cataract patients are at increased risk of developing herpes zoster compared to those without cataract. Through comprehensive data analysis, we seek to provide valuable insights into the relationship between these two common age-related diseases to inform public health strategies and clinical practice in Taiwan. METHODS Data source We utilized claims data spanning from 2013 to 2020 from the Taiwan National Health Insurance Program as our data source. Claims data contain comprehensive records of medical services utilized by beneficiaries, including outpatient visits, inpatient admissions, emergency room visits, and medication prescriptions. Study subjects and study design The cataract group included individuals aged 20 years or older with a new diagnosis of cataract (based on the International Classification of Diseases 9th and 10th Revisions, ICD-9 codes and ICD-10 codes). The index date was defined as the date of diagnosing cataract. For each individual with cataract, one individual without a diagnosis of cataract was randomly selected as the non-cataract group. Both cataract and non-cataract groups were matching on sex, age, and comorbidities through a 1:1 propensity score matching. To establish the temporal relationship, individuals with a diagnosis of herpes zoster prior to the index date were excluded from the study. Additionally, individuals with a follow-up period of less than one month were also excluded to ensure sufficient observation time (Fig. 1 ). Then a population-based, retrospective cohort study was designed to follow individuals over time to assess the primary outcome (Fig. 2 ). Comorbidities Some comorbidities before the index date were selected as covariables in statistical analyses to adjust for potential confounding effects, including alcohol-related disease, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension, all of which were relevant to many health outcomes. These comorbidities were diagnosed based on ICD-9 codes and ICD-10 codes. Primary outcome The primary outcome of the cohort study was defined as the occurrence of a new diagnosis of herpes zoster among the study subjects during the follow-up period (based on ICD-9 codes 053 and ICD-10 codes B02). All study subjects were monitored until the occurrence of a new diagnosis of herpes zoster or until the end of the cohort period in 2020. Statistical analysis If the P -value was less than 0.05, the null hypothesis was rejected, indicating that the observed results were statistically significant. Chi-square test was used to compare baseline characteristics of categorical variables between cataract patients and matched controls (non-cataract individuals). Student's t-test was used to compare baseline characteristics of continuous variables between cataract patients and matched controls. Incidence rate of herpes zoster was calculated as the number of new cases of herpes zoster identified during the follow-up period divided by the total person-years during the same period. The Kaplan-Meier curve was constructed to illustrate the cumulative incidence of herpes zoster events among cataract patients and matched controls. Subsequent statistical analysis by the log-rank test was conducted to assess whether there were significant differences in the cumulative incidence of herpes zoster between the two groups over the follow-up period. The Cox proportional hazards regression model was used to estimate hazard ratio (HR) and corresponding 95% confidence interval (CI) for the risk of developing herpes zoster in cataract patients compared with matched controls, adjusting for potential confounding variables. The assumption of proportional hazards in a Cox proportional hazards regression model was assessed using a test of scaled Schoenfeld residuals. The assumption was not violated in the study. In other words, the hazard ratio estimated by the Cox model could be considered valid. The SAS software was employed in all analyses of the study (version 9.4 for Windows; SAS Institute Inc., Cary, NC, USA). RESULTS Basic information of study subjects In Table 1 , the cohort study included 1,299,685 individuals in the cataract group. The mean age was 64 years older and about 43.9% of study subjects were male. The non-cataract group had similar numbers of study subjects and comparable distributions in terms of sex and age. Due to the large sample size, even after employing propensity score matching to account for age and comorbidities, slight discrepancies persisted among these variables, resulting in statistically significant differences (Chi-square test and Student's t-test, P < 0.001) . Table 1 Baseline information between cataract group and non-cataract group Cataract N = 1,299,685 Non-cataract N = 1,299,685 Variable n (%) n (%) P value * Sex 1.000 Male 570880 43.9 570880 43.9 Female 728805 56.1 728805 56.1 Age group (years) 0.356 20–39 14978 1.2 14977 1.2 40–64 668245 51.4 669397 51.5 65–84 616462 47.4 615311 47.3 Age (years), mean ± standard deviation † 64.0 ± 9.3 64.3 ± 9.9 < .001 Follow-up time(years) (median, IQR) † 4.8 2.8–6.5 7.9 7.9–7.9 < .001 Baseline comorbidities Alcohol-related disease 7527 0.6 8336 0.6 < .001 Cerebrovascular disease 87025 6.7 102598 7.9 < .001 Chronic obstructive pulmonary disease 96167 7.4 104893 8.1 < .001 Coronary artery disease 151439 11.7 161349 12.4 < .001 Diabetes mellitus 340153 26.2 337382 26.0 < .001 Hyperlipidemia 393000 30.2 354187 27.3 < .001 Hypertension 572113 44.0 584770 45.0 < .001 Data are presented as the number of subjects in each group, with percentages given in parentheses * Chi-square test † t -test comparing subjects with and without cataract IQR: interquartile range Incidence density of Herpes Zoster In Table 2 , the incidence rate of herpes zoster was 10.84 per 1000 person-years in the cataract group. In contrast, the incidence rate of herpes zoster was 6.36 per 1000 person-years in the non-cataract group. The cataract group had a higher incidence rate of herpes zoster compared with the non-cataract group (incidence rate ratio = 1.71, 95% CI = 1.69–1.72). After stratification by sex and age groups, the cataract group exhibited a higher incidence rate of herpes zoster compared to the non-cataract group. Specifically, the incidence ratio of herpes zoster was 1.82 in males with cataract compared to males without cataract, and 1.64 in females with cataract compared to females without cataract. Additionally, among age groups, the incidence ratio of herpes zoster was 1.55 in individuals aged 20–39 with cataract compared to those without cataract, 1.48 in individuals aged 40–64 with cataract compared to their non-cataract counterparts, and 1.96 in individuals aged 65–84 with cataract compared to those without cataract. Table 2 Incidence density of herpes zoster between subjects with and without cataract stratified by sex and age Cataract Non-cataract Variable N Event Person- years Incidence † N Event Person- years Incidence † IRR # (95% CI) P value All 1299685 64625 5959214 10.84 1299685 63676 10017354 6.36 1.71 (1.69–1.72) < .001 Sex Male 570880 25712 2582972 9.95 570880 24150 4414514 5.47 1.82 (1.79–1.85) < .001 Female 728805 38913 3376242 11.53 728805 39526 5602840 7.05 1.64 (1.61–1.66) < .001 Age group (years) 20–39 14978 244 65466 3.73 14977 282 117337 2.40 1.55 (1.31–1.84) < .001 40–64 668245 29348 3049079 9.63 669397 33576 5161761 6.50 1.48 (1.46–1.50) < .001 65–84 616462 35033 2844669 12.32 615311 29818 4738256 6.29 1.96 (1.93–1.99) < .001 † Incidence: per 1000 person-years. # IRR (incidence rate ratio): cataract vs. non-cataract (95% confidence interval) Table 3. Multivariable Cox model measuring hazard ratio and 95% confidence interval of herpes zoster associated with cataract and co-variables Crude Adjusted † Variable HR (95%CI) P value HR (95%CI) P value Sex (male vs. female) 0.82 0.81–0.83 < .001 0.81 0.80–0.82 < .001 Age group (years) 20–39 Ref. Ref. 40–64 2.66 2.44–2.90 < .001 2.35 2.15–2.56 < .001 65–84 2.97 2.72–3.23 < .001 2.50 2.30–2.73 < .001 Cataract (yes vs. no) 1.73 1.71–1.75 < .001 1.71 1.69–1.73 < .001 Baseline comorbidities (yes vs. no) Alcohol-related disease 0.69 0.63–0.75 < .001 0.77 0.71–0.84 < .001 Cerebrovascular disease 0.93 0.91–0.95 < .001 0.86 0.84–0.88 < .001 Chronic obstructive pulmonary disease 1.28 1.27–1.30 < .001 1.25 1.23–1.28 < .001 Coronary artery disease 1.21 1.20–1.23 < .001 1.10 1.08–1.12 < .001 Diabetes mellitus 1.02 1.01–1.03 0.003 0.89 0.88–0.90 0.003 Hyperlipidemia 1.32 1.30–1.33 < .001 1.25 1.24–1.27 < .001 Hypertension 1.28 1.27–1.30 < .001 1.21 1.20–1.23 < .001 † Adjusted for sex, age, alcohol-related disease, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension In Fig. 3 , the Kaplan-Meier curve reveals that the cumulative incidence of herpes zoster was indeed higher for the cataract group compared to the non-cataract group during the cohort period ( P < 0.001). It indicates a statistically significant difference between the cataract and non-cataract groups. Association between herpes zoster and cataract In Table 3, after adjusting for potential confounders using the Cox proportional hazards model, the hazard ratio (HR) for herpes zoster in the cataract group compared to the non-cataract group was 1.71 (95% CI = 1.69–1.73). The HR serves as reliable measures of the strength of these associations and it suggests a significant positive association between cataract and the risk of developing herpes zoster, indicating an increased likelihood of herpes zoster among individuals with cataract. The 95% CI of 1.69–1.73 reflects the precision of the estimate, providing a range within which we can be 95% confident that the true hazard ratio lies, suggesting a strong association between cataract and herpes zoster risk. DISCUSSION In this present cohort study, we found that the overall incidence rate of herpes zoster was higher in cataract patients compared with their respective matched controls across all three age groups (20–39, 40–64, and 65–84). Even though herpes zoster is typically more common among older individuals, there is still a significantly higher incidence ratio of herpes zoster observed in individuals aged 20–39 who have cataract compared to those without cataract (Table 2 ). This suggests that cataract may be associated with an increased risk of herpes zoster across different age groups, including younger adults. After adjusting for potential confounders such as age, sex, and comorbidities, we found that cataract patients had a 71% increased hazard of experiencing herpes zoster over time compared with their matched counterparts without cataract. This present study represents a novel contribution to the literature as there are no previous studies examining the association between cataract and the risk of herpes zoster. Our study fills a gap in the literature by conducting the first investigation of this issue. At present, cataract itself may not be the sole factor driving the increased risk of herpes zoster; instead, it could be a combination of factors including age-related changes in the immune system, comorbidities, potentially shared risk factors, and underlying health conditions between cataract and herpes zoster. Aged 20–39 individuals accounted for only 1.2% of all cataract patients in our study, indicating that cataract patients are predominantly older adults. This finding aligns with a meta-analysis by Hashemi et al., which reported an overall prevalence of cataract of 3.01% in individuals aged 20–39.( 3 ) Therefore, older adults with cataract might exhibit age-related immune dysfunction, particularly the waning of varicella-zoster virus-specific T cell-mediated immunity, rendering them more susceptible to the development of herpes zoster.( 15 – 18 ) Additionally, comorbidities such as diabetes mellitus, hypertension, and others could potentially link the association between cataract and herpes zoster.( 19 – 22 ) However, it is important to note that while these comorbidities can increase the risk, they are not necessarily direct causes of either cataract or herpes zoster. Several limitations should be addressed in this cohort study to ensure the validity and reliability of the findings. First, there might be inherent biases in the selection of study subjects, potentially affecting the generalizability of the results, but propensity score matching was conducted between cataract patients and controls to minimize differences in key characteristics. Second, the presence of unmeasured confounding variables, such as socioeconomic status, alcohol consumption, or smoking history, could impact the observed association between cataract and herpes zoster. We included alcohol-related disease as a proxy for alcohol consumption and included chronic obstructive pulmonary disease as a proxy for smoking history. This strengthens the validity of the study findings by minimizing the influence of these confounders on the results. Third, Variability in the measurement of cataract and herpes zoster could introduce measurement error, potentially biasing the estimates of association. However, based on the good quality of medical care in Taiwan, the likelihood of measurement error in the diagnosis of conditions like cataract and herpes zoster can be minimized. Fourth, when interpreting the study results, it is essential to consider that the characteristics of the study population, such as individual health conditions and demographics, and geographic location, may limit the generalizability of the findings to other populations. Despite the limitations mentioned earlier, there were several strengths associated with the study. First, having a large sample size could improve the statistical power of the study and could enhance the precision of the estimates and the ability to detect the differences between the cataract and non-cataract groups. Second, a long follow-up duration of 8 years allowed for the observation of outcomes over an extended period, providing a comprehensive understanding of the relationship between cataract and herpes zoster. Third, the novel findings provide updated insights into previously unexplored research areas. Fourth, employing rigorous study design and statistical analysis methods can minimize bias and improve the validity of the study. CONCLUSIONS Our population-based, retrospective cohort study reveals that cataract patients have a higher incidence of herpes zoster compared to those without cataract across different age groups, including younger adults. After adjusting for potential confounding variables, cataract patients remain at an increased risk of developing herpes zoster. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination. Given the absence of directly comparable studies, we suggest that further research is needed to confirm these results in the broader medical literature. Declarations -Ethics approval and consent to participate: All methods were performed in accordance with relevant guidelines and regulations. Patient identification numbers had been scrambled to ensure confidentiality. This study was approved by National Health Research Institute (NHRI, No: H112004) and the ethics committee of The Research Ethics Committee of Taichung Tzu Chi Hospital (REC No: REC111-58), and informed consent was waived. -Consent for publication: All authors have consent for publication. -Availability of data and materials: The insurance reimbursement claims data used in the study were available for public access. -Competing interests: The authors disclose that they have no conflict of interest. -Funding: This study did not receive external funding. -Authors' contributions: Shih-Wei Lai contributed to the conception of the article, initiated the draft of the article, and approved the final draft. Yu-Hung Kuo and Kuan-Fu Liao conducted data analysis. -Acknowledgements: No References Liu YC, Wilkins M, Kim T, et al. Cataracts Lancet. 2017;390:600–12. Cicinelli MV, Buchan JC, Nicholson M, et al. Cataracts Lancet. 2023;401:377–89. Hashemi H, Pakzad R, Yekta A, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis. Eye (Lond). 2020;34:1357–70. John AR, Canaday DH. Herpes Zoster in the Older Adult. Infect Dis Clin North Am. 2017;31:811–26. Saguil A, Kane S, Mercado M, et al. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017;96:656–63. Bader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med. 2013;125:78–91. Koshy E, Mengting L, Kumar H, et al. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol. 2018;84:251–62. Freer G, Pistello M. Varicella-zoster virus infection: natural history, clinical manifestations, immunity and current and future vaccination strategies. New Microbiol. 2018;41:95–105. Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84:274–80. Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines. 2015;3:109–20. Johnson RW. Herpes zoster and postherpetic neuralgia. Expert Rev Vaccines. 2010;9:21–6. Södergren E, Mårdberg K, Nishimwe M, et al. Incidence and Burden of Herpes Zoster in Sweden: A Regional Population-Based Register Study. Infect Dis Ther. 2024;13:121–40. Kempen JH, Sugar EA, Varma R, et al. Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections. Ophthalmology. 2014;121:2317–24. Schröder C, Enders D, Schink T, et al. Incidence of herpes zoster amongst adults varies by severity of immunosuppression. J Infect. 2017;75:207–15. Arvin AM. Cell-mediated immunity to varicella-zoster virus. J Infect Dis. 1992;166(Suppl 1):S35–41. Weinberg A, Levin MJ. VZV T cell-mediated immunity. Curr Top Microbiol Immunol. 2010;342:341–57. Pawelec G. Age and immunity: What is immunosenescence? Exp Gerontol. 2018;105:4–9. Lee KA, Flores RR, Jang IH, et al. Immune Senescence, Immunosenescence and Aging. Front Aging. 2022;3:900028. Mamatha BS, Nidhi B, Padmaprabhu CA, et al. Risk Factors for Nuclear and Cortical Cataracts: A Hospital Based Study. J Ophthalmic Vis Res. 2015;10:243–9. Kawai K, Yawn BP. Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2017;92:1806–21. Marra F, Parhar K, Huang B, et al. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis. 2020;7:ofaa005. Ang MJ, Afshari NA. Cataract and systemic disease: A review. Clin Exp Ophthalmol. 2021;49:118–27. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4335492","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":297541164,"identity":"843457ed-51d4-4d62-a513-33ad1a291f2c","order_by":0,"name":"Shih-Wei Lai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACxsYHDAwSMiAmM7Famg2AWniQtBDWySYBJEjQYnC8ua3qRo0FDwP76TTpAgabfHkH/mMSeLWcOdh2O+cY0GE8udukZzCkWW48wMyGV4vZjUSgFjagFgnebdI8DIcNDBuY2W7g1XL/YVtxzj+StNxgbGPObUPSIs9AQIv9mcRm6dw+CR42ntzN1jwGaQYGzMzmP/BpkWw//vBzzrc6OX72sxtv81TYGMi3Nz42wKcFDtjAJFCtwWGi1CMD+QaStYyCUTAKRsEwBwAOjjr3sBC06AAAAABJRU5ErkJggg==","orcid":"","institution":"China Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shih-Wei","middleName":"","lastName":"Lai","suffix":""},{"id":297541168,"identity":"9553c417-242b-4713-9e8b-b1ad3c5f87fc","order_by":1,"name":"Yu-Hung Kuo","email":"","orcid":"","institution":"Taichung Tzu Chi Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Hung","middleName":"","lastName":"Kuo","suffix":""},{"id":297541172,"identity":"134c2e2d-af50-41dc-b0be-557c946ef6a9","order_by":2,"name":"Kuan-Fu Liao","email":"","orcid":"","institution":"Tzu Chi University","correspondingAuthor":false,"prefix":"","firstName":"Kuan-Fu","middleName":"","lastName":"Liao","suffix":""}],"badges":[],"createdAt":"2024-04-27 21:39:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4335492/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4335492/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61918113,"identity":"08603e5b-fc8e-4e38-a3a1-516ff7de1f6a","added_by":"auto","created_at":"2024-08-07 05:28:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":551533,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4335492/v1/0d1583b0-9d3a-4e1f-9152-7cafffd0a97f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating the association between cataract patients and the risk of herpes zoster in a cohort study","fulltext":[{"header":"WHAT IS KNOWN","content":"\u003cp\u003e1. Cataract and herpes zoster are indeed prevalent conditions among the aging population and represent significant public health challenges worldwide due to their high prevalence, associated morbidity, and healthcare burden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHAT IS NEW HERE\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1. After adjusting for potential confounders, the hazard ratio was 1.71 for herpes zoster in individuals with cataract when compared to those without cataract (95%CI = 1.69-1.73).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTRANSLATIONAL IMPACT:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eCataract and herpes zoster are indeed prevalent conditions among the aging population and represent significant public health challenges worldwide due to their high prevalence, associated morbidity, and healthcare burden. Cataract is characterized by the progressive clouding of the lens that is associated with decreased visual acuity. Cataract is still the leading cause of blindness and affects approximately 95\u0026nbsp;million people globally.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The prevalence of cataract increases markedly with age, with a higher prevalence observed in older age groups. For example, in a meta-analysis conducted by Hashemi et al, the overall prevalence of cataract was 3.01% in ages 20\u0026ndash;39, 16.97% in ages 40\u0026ndash;59, and 54.38% in ages 60 or older, respectively.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) This is consistent with the well-established understanding that aging is a risk factor for the development of cataract.\u003c/p\u003e \u003cp\u003eHerpes zoster results from the reactivation of the varicella-zoster virus (VZV), which remains dormant in the sensory nerve ganglia after primary infection with varicella (chickenpox).(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Herpes zoster causes painful manifestations and subsequent impairment in quality of life, so it is a major health burden. The reactivation of VZV typically occurs later in life or occurs in other conditions that compromise the immune system.(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) While cell-mediated immunity to varicella-zoster virus declines with age, the risk of developing herpes zoster increases with age, especially after age 50.(\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) This decline in immunity is thought to be one of the key factors contributing to the increased risk of developing herpes zoster, especially in older adults. For example, the cumulative incidence of herpes zoster for people aged 50\u0026ndash;59 years was 3.59 per 1000 person-years and peaked at 9.94 per 1000 person-years for people aged\u0026thinsp;\u0026ge;\u0026thinsp;80 years in a population-based study conducted by S\u0026ouml;dergren et al in Sweden.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWhile both conditions share some risk factors, such as aging and impaired immune status,(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) the relationship between cataract and herpes zoster remains unexplored. Understanding the potential link between cataract and herpes zoster is of importance from both public health and clinical perspectives. Elucidating this association could provide preventive strategies aimed at reducing the burden of herpes zoster among cataract patients, particularly through targeted vaccination. Therefore, the present cohort study aimed to fill this knowledge gap by systematically investigating whether cataract patients are at increased risk of developing herpes zoster compared to those without cataract. Through comprehensive data analysis, we seek to provide valuable insights into the relationship between these two common age-related diseases to inform public health strategies and clinical practice in Taiwan.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003eWe utilized claims data spanning from 2013 to 2020 from the Taiwan National Health Insurance Program as our data source. Claims data contain comprehensive records of medical services utilized by beneficiaries, including outpatient visits, inpatient admissions, emergency room visits, and medication prescriptions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy subjects and study design\u003c/h2\u003e \u003cp\u003eThe cataract group included individuals aged 20 years or older with a new diagnosis of cataract (based on the International Classification of Diseases 9th and 10th Revisions, ICD-9 codes and ICD-10 codes). The index date was defined as the date of diagnosing cataract. For each individual with cataract, one individual without a diagnosis of cataract was randomly selected as the non-cataract group. Both cataract and non-cataract groups were matching on sex, age, and comorbidities through a 1:1 propensity score matching. To establish the temporal relationship, individuals with a diagnosis of herpes zoster prior to the index date were excluded from the study. Additionally, individuals with a follow-up period of less than one month were also excluded to ensure sufficient observation time (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Then a population-based, retrospective cohort study was designed to follow individuals over time to assess the primary outcome (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eComorbidities\u003c/h2\u003e \u003cp\u003eSome comorbidities before the index date were selected as covariables in statistical analyses to adjust for potential confounding effects, including alcohol-related disease, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension, all of which were relevant to many health outcomes. These comorbidities were diagnosed based on ICD-9 codes and ICD-10 codes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePrimary outcome\u003c/h2\u003e \u003cp\u003eThe primary outcome of the cohort study was defined as the occurrence of a new diagnosis of herpes zoster among the study subjects during the follow-up period (based on ICD-9 codes 053 and ICD-10 codes B02). All study subjects were monitored until the occurrence of a new diagnosis of herpes zoster or until the end of the cohort period in 2020.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIf the \u003cem\u003eP\u003c/em\u003e-value was less than 0.05, the null hypothesis was rejected, indicating that the observed results were statistically significant. Chi-square test was used to compare baseline characteristics of categorical variables between cataract patients and matched controls (non-cataract individuals). Student's t-test was used to compare baseline characteristics of continuous variables between cataract patients and matched controls. Incidence rate of herpes zoster was calculated as the number of new cases of herpes zoster identified during the follow-up period divided by the total person-years during the same period. The Kaplan-Meier curve was constructed to illustrate the cumulative incidence of herpes zoster events among cataract patients and matched controls. Subsequent statistical analysis by the log-rank test was conducted to assess whether there were significant differences in the cumulative incidence of herpes zoster between the two groups over the follow-up period. The Cox proportional hazards regression model was used to estimate hazard ratio (HR) and corresponding 95% confidence interval (CI) for the risk of developing herpes zoster in cataract patients compared with matched controls, adjusting for potential confounding variables. The assumption of proportional hazards in a Cox proportional hazards regression model was assessed using a test of scaled Schoenfeld residuals. The assumption was not violated in the study. In other words, the hazard ratio estimated by the Cox model could be considered valid. The SAS software was employed in all analyses of the study (version 9.4 for Windows; SAS Institute Inc., Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBasic information of study subjects\u003c/h2\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the cohort study included 1,299,685 individuals in the cataract group. The mean age was 64 years older and about 43.9% of study subjects were male. The non-cataract group had similar numbers of study subjects and comparable distributions in terms of sex and age. Due to the large sample size, even after employing propensity score matching to account for age and comorbidities, slight discrepancies persisted among these variables, resulting in statistically significant differences (Chi-square test and Student's t-test, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) .\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline information between cataract group and non-cataract group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,299,685\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNon-cataract\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,299,685\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e570880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e570880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e728805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e728805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e668245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e669397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e616462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e615311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e64.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e64.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time(years)\u003c/p\u003e \u003cp\u003e(median, IQR) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8\u0026ndash;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.9\u0026ndash;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol-related disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e340153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e337382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e393000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e354187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e572113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e584770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eData are presented as the number of subjects in each group, with percentages given in parentheses\u003c/p\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003eChi-square test\u003c/p\u003e \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cem\u003et\u003c/em\u003e-test comparing subjects with and without cataract\u003c/p\u003e \u003cp\u003eIQR: interquartile range\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eIncidence density of Herpes Zoster\u003c/h2\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the incidence rate of herpes zoster was 10.84 per 1000 person-years in the cataract group. In contrast, the incidence rate of herpes zoster was 6.36 per 1000 person-years in the non-cataract group. The cataract group had a higher incidence rate of herpes zoster compared with the non-cataract group (incidence rate ratio\u0026thinsp;=\u0026thinsp;1.71, 95% CI\u0026thinsp;=\u0026thinsp;1.69\u0026ndash;1.72). After stratification by sex and age groups, the cataract group exhibited a higher incidence rate of herpes zoster compared to the non-cataract group. Specifically, the incidence ratio of herpes zoster was 1.82 in males with cataract compared to males without cataract, and 1.64 in females with cataract compared to females without cataract. Additionally, among age groups, the incidence ratio of herpes zoster was 1.55 in individuals aged 20\u0026ndash;39 with cataract compared to those without cataract, 1.48 in individuals aged 40\u0026ndash;64 with cataract compared to their non-cataract counterparts, and 1.96 in individuals aged 65\u0026ndash;84 with cataract compared to those without cataract.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence density of herpes zoster between subjects with and without cataract stratified by sex and age\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eCataract\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eNon-cataract\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePerson-\u003c/p\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIncidence\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEvent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePerson-\u003c/p\u003e \u003cp\u003eyears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eIncidence\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eIRR\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1299685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5959214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1299685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e63676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10017354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.69\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e570880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2582972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e570880\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4414514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.79\u0026ndash;1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e728805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3376242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e728805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5602840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e7.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.61\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e117337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.31\u0026ndash;1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e668245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3049079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e669397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5161761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.46\u0026ndash;1.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e616462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2844669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e615311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4738256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(1.93\u0026ndash;1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"13\" nameend=\"c13\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Incidence: per 1000 person-years.\u003c/p\u003e \u003cp\u003e\u003csup\u003e#\u003c/sup\u003eIRR (incidence rate ratio): cataract vs. non-cataract (95% confidence interval)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;3. Multivariable Cox model measuring hazard ratio and 95% confidence interval of herpes zoster associated with cataract and co-variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eCrude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003eAdjusted\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male vs. female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026ndash;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80\u0026ndash;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.44\u0026ndash;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.15\u0026ndash;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.72\u0026ndash;3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.30\u0026ndash;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract (yes vs. no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.71\u0026ndash;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.69\u0026ndash;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline comorbidities (yes vs. no)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol-related disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u0026ndash;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71\u0026ndash;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026ndash;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u0026ndash;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026ndash;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.23\u0026ndash;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20\u0026ndash;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.08\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026ndash;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.88\u0026ndash;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30\u0026ndash;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.24\u0026ndash;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.27\u0026ndash;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20\u0026ndash;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Adjusted for sex, age, alcohol-related disease, cerebrovascular disease, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, hyperlipidemia, and hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the Kaplan-Meier curve reveals that the cumulative incidence of herpes zoster was indeed higher for the cataract group compared to the non-cataract group during the cohort period (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). It indicates a statistically significant difference between the cataract and non-cataract groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between herpes zoster and cataract\u003c/h2\u003e \u003cp\u003eIn Table\u0026nbsp;3, after adjusting for potential confounders using the Cox proportional hazards model, the hazard ratio (HR) for herpes zoster in the cataract group compared to the non-cataract group was 1.71 (95% CI\u0026thinsp;=\u0026thinsp;1.69\u0026ndash;1.73). The HR serves as reliable measures of the strength of these associations and it suggests a significant positive association between cataract and the risk of developing herpes zoster, indicating an increased likelihood of herpes zoster among individuals with cataract. The 95% CI of 1.69\u0026ndash;1.73 reflects the precision of the estimate, providing a range within which we can be 95% confident that the true hazard ratio lies, suggesting a strong association between cataract and herpes zoster risk.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this present cohort study, we found that the overall incidence rate of herpes zoster was higher in cataract patients compared with their respective matched controls across all three age groups (20\u0026ndash;39, 40\u0026ndash;64, and 65\u0026ndash;84). Even though herpes zoster is typically more common among older individuals, there is still a significantly higher incidence ratio of herpes zoster observed in individuals aged 20\u0026ndash;39 who have cataract compared to those without cataract (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This suggests that cataract may be associated with an increased risk of herpes zoster across different age groups, including younger adults. After adjusting for potential confounders such as age, sex, and comorbidities, we found that cataract patients had a 71% increased hazard of experiencing herpes zoster over time compared with their matched counterparts without cataract. This present study represents a novel contribution to the literature as there are no previous studies examining the association between cataract and the risk of herpes zoster. Our study fills a gap in the literature by conducting the first investigation of this issue.\u003c/p\u003e \u003cp\u003eAt present, cataract itself may not be the sole factor driving the increased risk of herpes zoster; instead, it could be a combination of factors including age-related changes in the immune system, comorbidities, potentially shared risk factors, and underlying health conditions between cataract and herpes zoster. Aged 20\u0026ndash;39 individuals accounted for only 1.2% of all cataract patients in our study, indicating that cataract patients are predominantly older adults. This finding aligns with a meta-analysis by Hashemi et al., which reported an overall prevalence of cataract of 3.01% in individuals aged 20\u0026ndash;39.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Therefore, older adults with cataract might exhibit age-related immune dysfunction, particularly the waning of varicella-zoster virus-specific T cell-mediated immunity, rendering them more susceptible to the development of herpes zoster.(\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Additionally, comorbidities such as diabetes mellitus, hypertension, and others could potentially link the association between cataract and herpes zoster.(\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) However, it is important to note that while these comorbidities can increase the risk, they are not necessarily direct causes of either cataract or herpes zoster.\u003c/p\u003e \u003cp\u003eSeveral limitations should be addressed in this cohort study to ensure the validity and reliability of the findings. First, there might be inherent biases in the selection of study subjects, potentially affecting the generalizability of the results, but propensity score matching was conducted between cataract patients and controls to minimize differences in key characteristics. Second, the presence of unmeasured confounding variables, such as socioeconomic status, alcohol consumption, or smoking history, could impact the observed association between cataract and herpes zoster. We included alcohol-related disease as a proxy for alcohol consumption and included chronic obstructive pulmonary disease as a proxy for smoking history. This strengthens the validity of the study findings by minimizing the influence of these confounders on the results. Third, Variability in the measurement of cataract and herpes zoster could introduce measurement error, potentially biasing the estimates of association. However, based on the good quality of medical care in Taiwan, the likelihood of measurement error in the diagnosis of conditions like cataract and herpes zoster can be minimized. Fourth, when interpreting the study results, it is essential to consider that the characteristics of the study population, such as individual health conditions and demographics, and geographic location, may limit the generalizability of the findings to other populations. Despite the limitations mentioned earlier, there were several strengths associated with the study. First, having a large sample size could improve the statistical power of the study and could enhance the precision of the estimates and the ability to detect the differences between the cataract and non-cataract groups. Second, a long follow-up duration of 8 years allowed for the observation of outcomes over an extended period, providing a comprehensive understanding of the relationship between cataract and herpes zoster. Third, the novel findings provide updated insights into previously unexplored research areas. Fourth, employing rigorous study design and statistical analysis methods can minimize bias and improve the validity of the study.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur population-based, retrospective cohort study reveals that cataract patients have a higher incidence of herpes zoster compared to those without cataract across different age groups, including younger adults. After adjusting for potential confounding variables, cataract patients remain at an increased risk of developing herpes zoster. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination. Given the absence of directly comparable studies, we suggest that further research is needed to confirm these results in the broader medical literature.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e-Ethics approval and consent to participate: \u003cstrong\u003eAll methods were performed in accordance with relevant guidelines and regulations.\u0026nbsp;\u003c/strong\u003ePatient identification numbers had been scrambled to ensure confidentiality. This study was approved by National Health Research Institute (NHRI, No: H112004) and the ethics committee of The Research Ethics Committee of Taichung Tzu Chi Hospital (REC No: REC111-58), and informed consent was waived.\u003c/p\u003e\n\u003cp\u003e-Consent for publication: \u0026nbsp;All authors have consent for publication.\u003c/p\u003e\n\u003cp\u003e-Availability of data and materials: The insurance reimbursement claims data used in the study were available for public access.\u003c/p\u003e\n\u003cp\u003e-Competing interests: The authors disclose that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e-Funding: This study did not receive external funding.\u003c/p\u003e\n\u003cp\u003e-Authors\u0026apos; contributions: Shih-Wei Lai contributed to the conception of the article, initiated the draft of the article, and approved the final draft. Yu-Hung Kuo and Kuan-Fu Liao conducted data analysis.\u003c/p\u003e\n\u003cp\u003e-Acknowledgements: No\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLiu YC, Wilkins M, Kim T, et al. Cataracts Lancet. 2017;390:600\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCicinelli MV, Buchan JC, Nicholson M, et al. Cataracts Lancet. 2023;401:377\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashemi H, Pakzad R, Yekta A, et al. Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis. Eye (Lond). 2020;34:1357\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohn AR, Canaday DH. Herpes Zoster in the Older Adult. Infect Dis Clin North Am. 2017;31:811\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaguil A, Kane S, Mercado M, et al. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017;96:656\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBader MS. Herpes zoster: diagnostic, therapeutic, and preventive approaches. Postgrad Med. 2013;125:78\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoshy E, Mengting L, Kumar H, et al. Epidemiology, treatment and prevention of herpes zoster: A comprehensive review. Indian J Dermatol Venereol Leprol. 2018;84:251\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreer G, Pistello M. Varicella-zoster virus infection: natural history, clinical manifestations, immunity and current and future vaccination strategies. New Microbiol. 2018;41:95\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84:274\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines. 2015;3:109\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson RW. Herpes zoster and postherpetic neuralgia. Expert Rev Vaccines. 2010;9:21\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eS\u0026ouml;dergren E, M\u0026aring;rdberg K, Nishimwe M, et al. Incidence and Burden of Herpes Zoster in Sweden: A Regional Population-Based Register Study. Infect Dis Ther. 2024;13:121\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKempen JH, Sugar EA, Varma R, et al. Risk of cataract among subjects with acquired immune deficiency syndrome free of ocular opportunistic infections. Ophthalmology. 2014;121:2317\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchr\u0026ouml;der C, Enders D, Schink T, et al. Incidence of herpes zoster amongst adults varies by severity of immunosuppression. J Infect. 2017;75:207\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArvin AM. Cell-mediated immunity to varicella-zoster virus. J Infect Dis. 1992;166(Suppl 1):S35\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinberg A, Levin MJ. VZV T cell-mediated immunity. Curr Top Microbiol Immunol. 2010;342:341\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePawelec G. Age and immunity: What is immunosenescence? Exp Gerontol. 2018;105:4\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee KA, Flores RR, Jang IH, et al. Immune Senescence, Immunosenescence and Aging. Front Aging. 2022;3:900028.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMamatha BS, Nidhi B, Padmaprabhu CA, et al. Risk Factors for Nuclear and Cortical Cataracts: A Hospital Based Study. J Ophthalmic Vis Res. 2015;10:243\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawai K, Yawn BP. Risk Factors for Herpes Zoster: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2017;92:1806\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarra F, Parhar K, Huang B, et al. Risk Factors for Herpes Zoster Infection: A Meta-Analysis. Open Forum Infect Dis. 2020;7:ofaa005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAng MJ, Afshari NA. Cataract and systemic disease: A review. Clin Exp Ophthalmol. 2021;49:118\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cataract, cohort study, herpes zoster, Taiwan","lastPublishedDoi":"10.21203/rs.3.rs-4335492/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4335492/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis cohort study aimed to elucidate whether cataract patients are at an increased risk of herpes zoster in Taiwan.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cohort of cataract patients, aged 20\u0026ndash;84 years, was assembled from electronic health records of Taiwan National Health Insurance Program spanning a period of eight years (2013\u0026ndash;2020). A non-cataract group matched for sex, age, and comorbidities was also identified from the same database. The incidence rate of herpes zoster within the follow-up period was calculated between the two groups. The risk of herpes zoster was compared between the two groups using a Cox proportional hazards model, adjusting for potential confounders.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 1,299,685 individuals in the cataract group. The mean age was 64 years old and about 43.9% of study subjects were male. The non-cataract group had similar numbers of study subjects and comparable distributions in terms of sex and age. The incidence rate of herpes zoster was 10.84 per 1000 person-years in the cataract group and 6.36 per 1000 person-years in the non-cataract group (incidence rate ratio\u0026thinsp;=\u0026thinsp;1.71, 95% CI\u0026thinsp;=\u0026thinsp;1.69\u0026ndash;1.72). After adjusting for potential confounders, the hazard ratio was 1.71 for herpes zoster in individuals with cataract when compared to those without cataract (95%CI\u0026thinsp;=\u0026thinsp;1.69\u0026ndash;1.73).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur cohort study reveals that cataract patients are at an increased risk of developing herpes zoster. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in cataract patients and the potential benefits of preventive measures such as vaccination.\u003c/p\u003e","manuscriptTitle":"Investigating the association between cataract patients and the risk of herpes zoster in a cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 19:15:42","doi":"10.21203/rs.3.rs-4335492/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"019e5aa2-2022-461c-822b-d673f0191bfb","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-07T05:11:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-07 19:15:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4335492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4335492","identity":"rs-4335492","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}