Elsevier

Mayo Clinic Proceedings

Volume 95, Issue 2, February 2020, Pages 283-292
Mayo Clinic Proceedings

Original article
Ultraviolet Radiation Exposure and the Risk of Herpes Zoster in Three Prospective Cohort Studies

https://doi.org/10.1016/j.mayocp.2019.08.022Get rights and content

Abstract

Objective

To examine the association between ultraviolet radiation (UVR) exposure and the risk of herpes zoster (HZ) in 3 prospective cohorts.

Patients and Methods

We included 205,756 participants from the Health Professionals Follow-up Study (HPFS; 1986-2008), Nurses’ Health Study (NHS; 1996-2012), and Nurses’ Health Study II (NHS II; 1991-2013). Ambient UVR exposure was based on updated geocoded address histories linked with a high-resolution spatiotemporal ultraviolet model. Incident HZ cases were identified by self-reported clinician diagnosis. Sunburn history and medical, lifestyle, and dietary factors were assessed using biennial questionnaires. Multivariable Cox proportional hazards models were used.

Results

A total of 24,201 cases of HZ occurred during 3,626,131 person-years. Ambient UVR exposure was associated with a higher risk of HZ in men (HPFS: multivariable-adjusted hazard ratio [MVHR] comparing highest vs lowest quintiles, 1.14; 95% CI, 1.02-1.29; P=.03 for trend) but not in women (NHS: MVHR, 0.99; 95% CI, 0.93-1.05; NHS II: MVHR, 0.96; 95% CI, 0.90-1.03). A higher lifetime number of severe sunburns was associated with a higher risk of HZ in all cohorts (HPFS: MVHR for ≥10 sunburns vs none, 1.08; 95% CI, 0.96-1.20; P=.02 for trend; NHS: MVHR, 1.14; 95% CI, 1.05-1.22; P=.01 for trend; NHS II: MVHR, 1.13; 95% CI, 1.00-1.28; P<.001 for trend).

Conclusion

Ambient UVR exposure was associated with a higher risk of HZ in men but not in women. A history of severe sunburn was associated with a modest increased risk of HZ in men and women, possibly because of immunosuppression from overexposure to the sun.

Section snippets

Study Design and Population

The HPFS began in 1986 and enrolled 51,529 male health professionals aged 40 to 75 years. The NHS began in 1976 and enrolled 121,700 female registered nurses aged 30 to 55 years. The NHS II began in 1989 and enrolled 116,430 female registered nurses aged 25 to 42 years. In all 3 ongoing cohort studies, participants are followed via biennial questionnaires on medical and lifestyle information. The follow-up time has exceeded 90% of eligible person-time in all 3 studies. Three large, long-term,

Results

Among 205,756 participants, the mean age was 52 years in the HPFS, 62 years in the NHS, and 36 years in the NHS II at baseline. The baseline characteristics of participants according to ambient UVR exposure status are presented in Table 1 and Supplemental Tables 1-3 (available online at http://www.mayoclinicproceedings.org). In all 3 cohorts, the characteristics of participants, including age, physical activity, and comorbidities, were similar across the quintiles of UVR exposure groups. Among

Discussion

We examined the association between UVR exposure and the risk of HZ in 3 large cohorts of men and women. Recent ambient UVR exposure was associated with a higher risk of HZ in men in the HPFS but not in women in the NHS and NHS II. In addition, skin reaction to prolonged sunlight was associated with a higher risk of HZ in men in the HPFS and in younger women in the NHS II. A higher lifetime number of severe or blistering sunburns was associated with an increased risk of HZ in all 3 cohorts.

This

Conclusion

Ambient UVR exposure was associated with a higher risk of HZ in men in the HPFS but not in women in the NHS and NHS II. A higher lifetime number of severe sunburns was associated with a modest increased risk of HZ in all 3 cohorts. Our findings highlight the importance of future research on long-term immunomodulating effects from overexposure to UVR.

Acknowledgments

We thank Elaine Coughlin-Gifford, MS, for her support with statistical programming. We also thank the participants and staff of the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study.

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    For editorial comment, see page 207

    Grant Support: The work was supported by grants UM1 CA186107, UM1 CA176726, UM1 CA167552, and DK091417 from the National Institutes of Health.

    Potential Competing Interests: Dr VoPham has received grant T32 CA009001 from the National Cancer Institute. Dr S.G. Curhan has received consultancy fees from Decibel Therapeutics (outside the submitted work). Dr G.C. Curhan has received a K24 grant from the National Institutes of Health. He has also received consultancy fees from Allena Pharmaceuticals, Shire, AstraZeneca, RenalGuard, Merck, and Decibel Therapeutics; receives royalties from UpToDate; owns stocks in Allena Pharmaceuticals; and was Editor-in-Chief of the Clinical Journal of American Society of Nephrology (outside the submitted work). The other authors report no competing interests.

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