Incidence of mortality from COVID-19 increased with age, deprivation, and male sex, and with Indian or Pakistani ethnicity

Covid vaccine

Researchers have identified groups of people most at risk of dying from or experiencing severe symptoms of COVID-19 after receiving one or two doses of a COVID-19 vaccine.

The study, conducted by the University of Oxford, examined risk of severe COVID-19 leading to hospitalisation or death from 14 days after a second vaccine dose, when substantial immunity should be expected.

The researchers used the QCovid tool to analyse outcomes in adults aged 19 years and over between 8 December 2020 and 15 June 2021.

They used national linked datasets from general practice, the national immunisation programme, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing services, death registry information, and hospital episode data to analyse a sample of more than 6.9 million vaccinated adults. Of those, 74.1% had received two vaccine doses.

The sample included 2031 COVID-19 deaths and 1929 COVID-related hospital admissions, of which 81 deaths (4%) and 71 admissions (3.7%) occurred 14 days or more after the second vaccine dose.

The mean age of people in the cohort was 52 years.

New tool will help to identify risk factors

Cause-specific hazard ratios (HR) were highest for patients with:

  • Down’s syndrome (HR 12.7)

  • kidney transplantation (HR 8.1)

  • sickle cell disease (HR 7.7)

  • chemotherapy (HR 4.3)

  • care home residency (HR 4.1)

  • HIV/acquired immune deficiency syndrome (HR 3.3)

  • liver cirrhosis (HR 3.0)

  • neurological conditions (HR 2.6)

  • recent bone marrow transplantation or a solid organ transplantation at any time (HR 2.5)

  • dementia (HR 2.2)

  • Parkinson’s disease (HR 2.2).

The study, published in the BMJ, found that the incidence of mortality from COVID-19 increased with age, deprivation, and male sex, and with Indian and Pakistani ethnicity.

Best clinical research data in the world

Julia Hippisley-Cox, Professor of Clinical Epidemiology and General Practice at the University of Oxford and who co-authored the paper, said: ‘The UK was the first place to implement a vaccination programme and has some of the best clinical research data in the world. We have developed this new tool using the QResearch database to help the NHS identify which patients are at highest risk of serious outcomes despite vaccination, for targeted intervention.

‘This new tool can also inform discussions between doctors and patients about the level of risk, to aid shared decision making.’

Aziz Sheikh, Professor of Primary Care Research and Development at the University of Edinburgh and co-author of the paper, said: ‘Our new QCovid tool, developed with the help of experts from across the UK, has been designed to identify those at high risk who may benefit from interventions such as vaccine booster doses or new treatments such as monoclonal antibodies, which can help reduce the risk of progression [of] SARS-CoV-2 infection to serious COVID-19 outcomes.’

Professor Hippisley-Cox added: ‘Individual risk will always depend on individual choices as well as the current prevalence of the disease. However, we hope that this new tool will help shared decision making and more personalised risk assessment.’

This article originally appeared on Medscape, part of the Medscape Professional Network.

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