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Original Article | Open Access

Association of Chronic Diseases With Herpes Zoster in China: A Nationwide Population‐Based Survey

Wenhui Zhu1,2, Yiqi Xia1,2, Yanran Wang2, Zhenyu Shi2, Yang Shen1,2, Chengsen Cui2, Jinxu Ai1,2, Yemin Yuan2, Xin Ye3,4, Dawei Zhu5, Ping He2,6,7,8 ( )
School of Public Health, Peking University, Beijing, China
China Center for Health Development Studies, Peking University, Beijing, China
Institute for Global Public Policy, Fudan University, Shanghai, China
LSE‐Fudan Research Centre for Global Public Policy, Fudan University, Shanghai, China
International Research Centre for Medicinal Administration (IRCMA), Peking University, Beijing, China
Beijing Institute of Health Development, Peking University, Beijing, China
National Health Commission Key Laboratory of Health System Reform and Governance, Peking University, Beijing, China
State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
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Abstract

Background

The global burden of herpes zoster (HZ) is rising, posing a major public health challenge, especially among aging populations with high chronic disease prevalence. Although chronic conditions are known risk factors, population‐based evidence from China remains scarce.

Objective

The aim of the study is to examine the association between chronic diseases and HZ using nationally representative data from China, considering demographic and lifestyle factors.

Methods

We conducted a national population‐based survey using data from the 2024 China Family Panel Survey. A probability proportional to size sampling method was employed, covering 25 provincial‐level administrative divisions and representing 95% of the population in Chinese mainland. A structured questionnaire collected data on HZ diagnosis, chronic disease status, and demographics. Incidence rates were calculated, and multivariable logistic regression was used to estimate adjusted odds ratio (aOR).

Results

Among 27,868 participants (21,496 adults; 6372 minors), 809 adult HZ cases were identified, with 64.40% (n = 521) having at least one chronic condition. Female adults with chronic diseases had a higher incidence (12.94/1000 person‐years [PY]; 95% confidence intervals [CI]: 11.45–14.56) than males (8.78/1000 PY; 95% CI: 7.55–10.12). Incidence increased with age, from 8.07/1000 PY (95% CI: 4.45–13.10) in those aged 18–29 to 13.36/1000 PY (95% CI: 11.08–15.96) in those ≥ 70. Chronic disease was associated with elevated HZ risk (aOR = 1.84; 95% CI: 1.51–2.24). Among 14 chronic conditions, heart disease showed the strongest association (aOR = 2.91; 95% CI: 2.07–4.10), followed by diabetes (aOR = 2.04; 95% CI: 1.48–2.80) and hypertension (aOR = 1.89; 95% CI: 1.47–2.42).

Conclusions

Chronic diseases, particularly cardiovascular and metabolic conditions, are significantly associated with increased HZ risk. These findings highlight the need for targeted HZ prevention strategies, including vaccination, among high‐risk groups in China.

Graphical Abstract

Chronic disease was associated with elevated herpes zoster risk (aOR = 1.84, 95% CI: 1.51–2.24). Among 14 chronic conditions, heart disease showed the strongest association (aOR = 2.91, 95% CI: 2.07–4.10), followed by diabetes (aOR = 2.04, 95% CI: 1.48–2.80) and hypertension (aOR = 1.89, 95% CI: 1.47–2.42).

Keywords

chronic diseaseepidemiologyherpes zosternationwide survey

References

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Health Care Science
Volume 5 Issue 3,
June 2026
Pages 187-195
DOI: 10.1002/hcs2.70065

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Cite this article:
Zhu W, Xia Y, Wang Y, et al. Association of Chronic Diseases With Herpes Zoster in China: A Nationwide Population‐Based Survey. Health Care Science, 2026, 5(3): 187-195. https://doi.org/10.1002/hcs2.70065

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Received: 27 July 2025
Revised: 23 November 2025
Accepted: 08 December 2025
Published: 27 March 2026
© 2026 The Author(s). Tsinghua University Press.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.