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Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales

Steven Kerr, Stuart Bedston, Genevieve Cezard, Alexia Sampri, Siobhan Murphy, Declan T Bradley, Kirsty Morrison, Ashley Akbari Orcid Logo, William Whiteley, Christopher Sullivan, Lynsey Patterson, Kamlesh Khunti, Spiros Denaxas, Thomas Bolton, Samaira Khan, Alan Keys, David Weatherill, Karen Mooney, Jan Davies, Lewis Ritchie, Jim McMenamin, Frank Kee, Angela Wood, Ronan Lyons Orcid Logo, Cathie Sudlow, Chris Robertson, Aziz Sheikh

The Lancet, Volume: 403, Issue: 10426, Pages: 554 - 566

Swansea University Authors: Stuart Bedston, Ashley Akbari Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1016/s0140-6736(23)02467-4

Abstract

BackgroundUndervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes—ie, COVID-19 hospitalisation or death—compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses)...

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Published in: The Lancet
ISSN: 0140-6736
Published: Elsevier BV 2024
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We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK.MethodsWe used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022.FindingsThe numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94–326) in the 5–15 years age group, 1544 (1399–1689) in those aged 16–74 years, and 5426 (5340–5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61–2·78) for one dose fewer than recommended, 3·13 (2·93–3·34) for two fewer, 3·61 (3·13–4·17) for three fewer, and 3·08 (2·89–3·29) for four fewer.InterpretationRates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes.</abstract><type>Journal Article</type><journal>The Lancet</journal><volume>403</volume><journalNumber>10426</journalNumber><paginationStart>554</paginationStart><paginationEnd>566</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0140-6736</issnPrint><issnElectronic/><keywords/><publishedDay>8</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-02-08</publishedDate><doi>10.1016/s0140-6736(23)02467-4</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>K Research and Innovation National Core Studies: Data and Connectivity.</funders><projectreference/><lastEdited>2024-04-04T14:11:18.7144024</lastEdited><Created>2024-02-08T06:39:55.0707546</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Steven</firstname><surname>Kerr</surname><order>1</order></author><author><firstname>Stuart</firstname><surname>Bedston</surname><order>2</order></author><author><firstname>Genevieve</firstname><surname>Cezard</surname><order>3</order></author><author><firstname>Alexia</firstname><surname>Sampri</surname><order>4</order></author><author><firstname>Siobhan</firstname><surname>Murphy</surname><order>5</order></author><author><firstname>Declan T</firstname><surname>Bradley</surname><order>6</order></author><author><firstname>Kirsty</firstname><surname>Morrison</surname><order>7</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>8</order></author><author><firstname>William</firstname><surname>Whiteley</surname><order>9</order></author><author><firstname>Christopher</firstname><surname>Sullivan</surname><order>10</order></author><author><firstname>Lynsey</firstname><surname>Patterson</surname><order>11</order></author><author><firstname>Kamlesh</firstname><surname>Khunti</surname><order>12</order></author><author><firstname>Spiros</firstname><surname>Denaxas</surname><order>13</order></author><author><firstname>Thomas</firstname><surname>Bolton</surname><order>14</order></author><author><firstname>Samaira</firstname><surname>Khan</surname><order>15</order></author><author><firstname>Alan</firstname><surname>Keys</surname><order>16</order></author><author><firstname>David</firstname><surname>Weatherill</surname><order>17</order></author><author><firstname>Karen</firstname><surname>Mooney</surname><order>18</order></author><author><firstname>Jan</firstname><surname>Davies</surname><order>19</order></author><author><firstname>Lewis</firstname><surname>Ritchie</surname><order>20</order></author><author><firstname>Jim</firstname><surname>McMenamin</surname><order>21</order></author><author><firstname>Frank</firstname><surname>Kee</surname><order>22</order></author><author><firstname>Angela</firstname><surname>Wood</surname><order>23</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>24</order></author><author><firstname>Cathie</firstname><surname>Sudlow</surname><order>25</order></author><author><firstname>Chris</firstname><surname>Robertson</surname><order>26</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>27</order></author></authors><documents><document><filename>65592__29625__04af9dc7cbd54af497d2bf518b812c70.pdf</filename><originalFilename>65592.pdf</originalFilename><uploaded>2024-03-05T09:01:20.2420403</uploaded><type>Output</type><contentLength>580013</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2023 The Author(s). 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spelling v2 65592 2024-02-08 Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales c79d07eaba5c9515c0df82b372b76a41 Stuart Bedston Stuart Bedston true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2024-02-08 HDAT BackgroundUndervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes—ie, COVID-19 hospitalisation or death—compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK.MethodsWe used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022.FindingsThe numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94–326) in the 5–15 years age group, 1544 (1399–1689) in those aged 16–74 years, and 5426 (5340–5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61–2·78) for one dose fewer than recommended, 3·13 (2·93–3·34) for two fewer, 3·61 (3·13–4·17) for three fewer, and 3·08 (2·89–3·29) for four fewer.InterpretationRates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. Journal Article The Lancet 403 10426 554 566 Elsevier BV 0140-6736 8 2 2024 2024-02-08 10.1016/s0140-6736(23)02467-4 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University K Research and Innovation National Core Studies: Data and Connectivity. 2024-04-04T14:11:18.7144024 2024-02-08T06:39:55.0707546 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Steven Kerr 1 Stuart Bedston 2 Genevieve Cezard 3 Alexia Sampri 4 Siobhan Murphy 5 Declan T Bradley 6 Kirsty Morrison 7 Ashley Akbari 0000-0003-0814-0801 8 William Whiteley 9 Christopher Sullivan 10 Lynsey Patterson 11 Kamlesh Khunti 12 Spiros Denaxas 13 Thomas Bolton 14 Samaira Khan 15 Alan Keys 16 David Weatherill 17 Karen Mooney 18 Jan Davies 19 Lewis Ritchie 20 Jim McMenamin 21 Frank Kee 22 Angela Wood 23 Ronan Lyons 0000-0001-5225-000X 24 Cathie Sudlow 25 Chris Robertson 26 Aziz Sheikh 27 65592__29625__04af9dc7cbd54af497d2bf518b812c70.pdf 65592.pdf 2024-03-05T09:01:20.2420403 Output 580013 application/pdf Version of Record true © 2023 The Author(s). This is an Open Access article under the CC BY 4.0 license. true eng https://creativecommons.org/licenses/by/4.0/
title Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
spellingShingle Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
Stuart Bedston
Ashley Akbari
Ronan Lyons
title_short Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
title_full Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
title_fullStr Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
title_full_unstemmed Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
title_sort Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
author_id_str_mv c79d07eaba5c9515c0df82b372b76a41
aa1b025ec0243f708bb5eb0a93d6fb52
83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv c79d07eaba5c9515c0df82b372b76a41_***_Stuart Bedston
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Stuart Bedston
Ashley Akbari
Ronan Lyons
author2 Steven Kerr
Stuart Bedston
Genevieve Cezard
Alexia Sampri
Siobhan Murphy
Declan T Bradley
Kirsty Morrison
Ashley Akbari
William Whiteley
Christopher Sullivan
Lynsey Patterson
Kamlesh Khunti
Spiros Denaxas
Thomas Bolton
Samaira Khan
Alan Keys
David Weatherill
Karen Mooney
Jan Davies
Lewis Ritchie
Jim McMenamin
Frank Kee
Angela Wood
Ronan Lyons
Cathie Sudlow
Chris Robertson
Aziz Sheikh
format Journal article
container_title The Lancet
container_volume 403
container_issue 10426
container_start_page 554
publishDate 2024
institution Swansea University
issn 0140-6736
doi_str_mv 10.1016/s0140-6736(23)02467-4
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundUndervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes—ie, COVID-19 hospitalisation or death—compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK.MethodsWe used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022.FindingsThe numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94–326) in the 5–15 years age group, 1544 (1399–1689) in those aged 16–74 years, and 5426 (5340–5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61–2·78) for one dose fewer than recommended, 3·13 (2·93–3·34) for two fewer, 3·61 (3·13–4·17) for three fewer, and 3·08 (2·89–3·29) for four fewer.InterpretationRates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes.
published_date 2024-02-08T14:11:15Z
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