ABSTRACT
Background: The emergence of the COVID-19 vaccination has been critical in changing the course of the COVID-19 pandemic, with estimates suggesting vaccinations have prevented millions of deaths worldwide. To ensure protection remains high in groups at high-risk, booster vaccinations in the UK have been targeted based on age and clinical vulnerabilities. We sought to identify adults at increased risk of COVID-19 death, and compared to non-COVID-19 risk, despite having received a booster dose as part of the 2022 autumn vaccination campaign in England. Methods: We undertook a national retrospective cohort study using data from the 2021 Census linked to electronic health records. We fitted cause-specific Cox regression to examine the association between a range of health conditions and the risk of COVID-19 death and all-other-cause death for adults aged 50-100-years in England vaccinated with a booster in autumn 2022. Findings: Our total population was 14,644,570 people; there were 6,800 COVID-19 deaths (52. and 150,075 non-COVID-19 deaths. Having learning disabilities or Down Syndrome (hazard ratio=5.07;conficence interval=3.69-6.98), pulmonary hypertension or fibrosis(2.88;2.43-3.40), motor neuron disease, multiple sclerosis, myasthenia or Huntington's disease (2.94, 1.82-4.74), cancer of blood and bone marrow (3.11;2.72-3.56), Parkinson's disease (2.74;2.34-3.20), lung or oral cancer (2.57;2.04 to 3.24), dementia (2.64;2.46 to 2.83) or liver cirrhosis (2.65;1.95 to 3.59) was associated with an increased risk of COVID-19 death. Individuals with cancer of the blood or bone marrow, chronic kidney disease, cystic fibrosis, pulmonary hypotension or fibrosis, or rheumatoid arthritis or systemic lupus erythematosus had a significantly higher risk of COVID-19 death relative to other causes of death compared with individuals who did not have diagnoses of these comorbidities. Interpretation: We identify groups who are at increased risk of COVID-19 death relative to non-COVID-19 deaths. Vulnerable groups should continue to be prioritised for COVID-19 booster doses to minimise the risk of COVID-19 deaths.
Subject(s)
COVID-19 , DeathABSTRACT
Objectives: To assess whether there is a change in the incidence of cardiac and all-cause death in young people following COVID-19 vaccination or SARS-CoV-2 infection in unvaccinated individuals. Design: Self-controlled case series. Setting: National, linked electronic health record data in England. Study population: Individuals aged 12-29 who had received at least one dose of COVID-19 vaccination and died between 8 December 2020 and 2 February 2022 and registered by 16 February 2022 within 12 weeks of COVID-19 vaccination; Individuals aged 12-29 who died within 12 weeks of testing positive for SARS-CoV-2. Main outcome measures: Cardiac and all-cause deaths occurring within 12 weeks of vaccination or SARS-CoV-2 infection. Results: Compared to the baseline period, there was no evidence of a change in the incidence of cardiac death in the six weeks after vaccination, whether for each of weeks 1 to 6 or the whole six-week period. There was a decrease in the risk of all-cause death in the first week after vaccination and no change in each of weeks 2 to 6 after vaccination or whole six-week period after vaccination. Subgroup analyses by sex, age, vaccine type, and last dose also showed no change in the risk of death in the first six weeks after vaccination. There was a large increase in the incidence of cardiac and all-cause death in the overall risk period after SARS-CoV-2 infection among the unvaccinated. Conclusion: There is no evidence of an association between COVID-19 vaccination and an increased risk of death in young people. By contrast, SARS-CoV-2 infection was associated with substantially higher risk of cardiac related death and all-cause death.