JOURNAL READING

A case control study on family history as a

risk factor for herpes zoster and associated
outcomes, Beijing, China

USWATUN HASANAH 15711204

Apa itu Herpes Zoster (HZ) ?
LATAR BELAKANG
METODE Identifikasi dan Pendaftaran Subjek

 Studi : population-based matched case control

 Di tiga distrik di wilayah Beijing :
1) Xicheng terletak di jantung kota Beijing
2) Changping terletak di pinggiran utara
3) Miyun terletak lebih jauh di timur laut di daerah pedesaan
 8 kota setuju menjadi responden
 Semua penduduk yang telah tinggal di daerah tersebut selama setidaknya
enam bulan selama 1 Desember 2011 hingga 30 November 2012 memenuhi
syarat untuk menjadi responden
 Semua peserta yang memenuhi syarat diwawancara secara langsung
METODE Pengumpulan Data

 905 subjek (227 pasien kasus dan 678 kontrol)

 Pasien kasus & kontrol → diwawancarai menggunakan formulir standar
untuk mengumpulkan data mengenai karakteristik sosiodemografi dan
kondisi kronis.
 Karakteristik HZ → termasuk tanggal onset ruam, apakah mereka memiliki
episode HZ sebelumnya (HZ rekuren), keparahan nyeri (tidak ada, nyeri
ringan, sedang, atau berat), dan durasi nyeri setelah ruam sembuh.
 PHN → nyeri yang bertahan >90 hari setelah ruam HZ sembuh.
 Data riwayat keluarga HZ → apakah ada kerabat dengan riwayat HZ →
menentukan tingkat hubungan darah (tingkat pertama vs no tingkat
pertama)
METODE Analisis Statistik

 Distribusi faktor sosiodemografi masing-masing dihitung dengan

menggunakan Mantel-Haenszel chi-square atau student t-test
 Trend test digunakan untuk menilai hubungan riwayat keluarga HZ
dengan hasil HZ yang berbeda dengan berbagai tingkatan (misal, dose
response), seperti HZ primer dan HZ rekuren, HZ dengan dan tanpa PHN,
dan HZ dengan keparahan nyeri yang berbeda.
 Semua analisis dilakukan dengan SAS versi 9.3 (SAS Inc., Cary, NC).
HASIL
HASIL
SIMPULAN

 Terdapat hubungan antara riwayat

keluarga HZ dengan kejadian HZ.
 Riwayat keluarga HZ lebih kuat terkait
dengan HZ rekuren dibandingkan HZ primer
dan HZ dengan nyeri sedang atau berat
daripada tanpa nyeri ringan.
 Preventif : vaksin HZ untuk orang dengan
riwayat keluarga HZ
CRITICAL APPRAISAL
DOES THE STUDY ADDRESS A CLEAR QUESTION?
1. Is there a clearly focused question? yes
IS THE STUDY DESIGN VALID?

yes
2. Were there clearly defined groups of patients, similar in all
important ways other than exposure to the treatment or other
causes?
IS THE STUDY DESIGN VALID?

yes
3. Were treatments / exposures and clinical outcomes measured in
the same way for both groups?
IS THE STUDY DESIGN VALID?

yes
4. Was the assessment of outcomes either objective or blinded to
exposure?
IS THE STUDY DESIGN VALID?

no
5. Was the follow-up of study patients sufficiently long for the
outcome to occur?
IS THE STUDY DESIGN VALID?
6. Do the results of the harm study fulfil some of the diagnostic tests for
causation?
Consider:
 Is it clear that the exposure preceded the onset of the outcome? yes
IS THE STUDY DESIGN VALID?
6. Do the results of the harm study fulfil some of the diagnostic tests for
causation?
Consider:
 Is there a dose-response gradient? yes
IS THE STUDY DESIGN VALID?
6. Do the results of the harm study fulfil some of the diagnostic tests for
causation?
Consider:
 Is there any positive evidence from a “dechallenge- rechallenge”
study?
can’t tell
IS THE STUDY DESIGN VALID?
6. Do the results of the harm study fulfil some of the diagnostic tests for
causation?
Consider:
 Is the association consistent from study to study? yes
IS THE STUDY DESIGN VALID?
6. Do the results of the harm study fulfil some of the diagnostic tests for
causation?
Consider:
 Does the association make biological sense? yes
ARE THE RESULTS IMPORTANT?

Exposure/Outcome HZ No HZ Total

Riwayat Keluarga HZ 24 (a) 33 (b) 57

No Riwayat Keluarga HZ 203 (c) 645 (d) 848

Total 227 678 905

OR = (a x d) : (b x c)
= (24 x 645) : (33 x 203)
= 15.480 : 6.699
= 2,4
ARE THE RESULTS IMPORTANT?
7. How strong is the association between exposure and outcome, i.e.
the estimate of risk?

OR = 2,4

 kelompok dengan penggunaan riwayat keluarga HZ berisiko 2,4 kali

lebih besar mengalami HZ dibandingkan dengan kelompok yang tidak
memiliki riwayat keluarga HZ.
ARE THE RESULTS IMPORTANT?
8. How precise is the estimate of risk?
Were the results presented with confidence intervals?
ARE THE RESULTS APPLICABLE FOR MY PATIENT?

no
9. Is my patient so different from those included in the study that its
results don’t apply?

What is my patient’s risk of the adverse event / potential benefit

no
10.
from therapy?

no
11. What are my patient’s preferences, concerns, and expectations
from this treatment?

12. What are my patient’s preferences, concerns and expectations

from this treatment? no