London School of Hygiene & Tropical Medicine, London, UK.
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK.
BMJ Open. 2023 Jan 31;13(1):e066164. doi: 10.1136/bmjopen-2022-066164.
To characterise factors associated with COVID-19 vaccine uptake among people with kidney disease in England.
Retrospective cohort study using the OpenSAFELY-TPP platform, performed with the approval of NHS England.
Individual-level routine clinical data from 24 million people across GPs in England using TPP software. Primary care data were linked directly with COVID-19 vaccine records up to 31 August 2022 and with renal replacement therapy (RRT) status via the UK Renal Registry (UKRR).
A cohort of adults with stage 3-5 chronic kidney disease (CKD) or receiving RRT at the start of the COVID-19 vaccine roll-out was identified based on evidence of reduced estimated glomerular filtration rate (eGFR) or inclusion in the UKRR.
Dose-specific vaccine coverage over time was determined from 1 December 2020 to 31 August 2022. Individual-level factors associated with receipt of a 3-dose or 4-dose vaccine series were explored via Cox proportional hazards models.
992 205 people with stage 3-5 CKD or receiving RRT were included. Cumulative vaccine coverage as of 31 August 2022 was 97.5%, 97.0% and 93.9% for doses 1, 2 and 3, respectively, and 81.9% for dose 4 among individuals with one or more indications for eligibility. Delayed 3-dose vaccine uptake was associated with younger age, minority ethnicity, social deprivation and severe mental illness-associations that were consistent across CKD severity subgroups, dialysis patients and kidney transplant recipients. Similar associations were observed for 4-dose uptake.
Although high primary vaccine and booster dose coverage has been achieved among people with kidney disease in England, key disparities in vaccine uptake remain across clinical and demographic groups and 4-dose coverage is suboptimal. Targeted interventions are needed to identify barriers to vaccine uptake among under-vaccinated subgroups identified in the present study.
描述英格兰肾病患者 COVID-19 疫苗接种率相关因素。
利用 NHS England 批准的 OpenSAFELY-TPP 平台进行回顾性队列研究。
使用 TPP 软件的英格兰 2400 万全科医生的个人临床数据。初级保健数据与截至 2022 年 8 月 31 日的 COVID-19 疫苗记录直接相关，并通过英国肾脏登记册（UKRR）与肾脏替代治疗（RRT）状态相关联。
根据肾小球滤过率估计值降低（eGFR）的证据或纳入 UKRR，确定了 COVID-19 疫苗推出开始时患有 3-5 期慢性肾脏病（CKD）或接受 RRT 的成年人队列。
从 2020 年 12 月 1 日至 2022 年 8 月 31 日，确定了特定剂量疫苗的随时间推移的覆盖率。通过 Cox 比例风险模型探索与接受 3 剂或 4 剂疫苗系列相关的个体因素。
共纳入 992205 名患有 3-5 期 CKD 或接受 RRT 的患者。截至 2022 年 8 月 31 日，一剂、两剂和三剂疫苗的累计疫苗覆盖率分别为 97.5%、97.0%和 93.9%，一剂疫苗覆盖率为 81.9%，有一个或多个符合资格的适应症的个体。延迟接种 3 剂疫苗与年龄较小、少数民族、社会贫困和严重精神疾病有关-这些关联在 CKD 严重程度亚组、透析患者和肾移植受者中是一致的。对于 4 剂疫苗接种，也观察到了类似的关联。
尽管英格兰肾病患者的初级疫苗和加强剂接种率较高，但在临床和人口统计学群体中，疫苗接种率仍存在明显差异，4 剂疫苗接种率不理想。需要采取有针对性的干预措施，以确定本研究中确定的未充分接种疫苗亚组接种疫苗的障碍。
