疫苗接种不足与严重 COVID-19 结局：英格兰、北爱尔兰、苏格兰和威尔士的全国队列研究的荟萃分析。

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

出版信息

Lancet. 2024 Feb 10;403(10426):554-566. doi: 10.1016/S0140-6736(23)02467-4. Epub 2024 Jan 15.

Abstract

BACKGROUND

Undervaccination (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.

METHODS

We 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.

FINDINGS

The 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.

INTERPRETATION

Rates 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.

FUNDING

UK Research and Innovation National Core Studies: Data and Connectivity.

摘要

背景

与完全接种（接种推荐剂量的 SARS-CoV-2 疫苗）相比，未完全接种（接种少于推荐剂量的 SARS-CoV-2 疫苗）可能与 COVID-19 重症结局（即 COVID-19 住院或死亡）的风险增加相关。我们试图确定与未完全接种相关的因素，并调查在英国每个国家和整个英国未完全接种的人群中 COVID-19 重症结局的风险。

方法

我们使用匿名、协调的电子健康记录数据进行全人群覆盖的队列研究，在英格兰、北爱尔兰、苏格兰和威尔士进行。要求参与者至少 5 岁才能纳入队列。我们估计截至 2022 年 6 月 1 日未完全接种的调整比值比。我们还估计了 2022 年 6 月 1 日至 9 月 30 日期间 COVID-19 重症结局的调整危险比（aHR），将未完全接种作为时间依赖性暴露因素。我们在英国范围内进行固定效应荟萃分析，合并了来自国家特定分析的结果。我们估计了在 2022 年 6 月 1 日，假设英国每个人都完全接种疫苗的情况下，与 COVID-19 重症结局相关的减少量。

结果

2022 年 6 月 1 日未完全接种的人数为英格兰 58967360 人中的 26985570 人（45.8%），北爱尔兰 1885670 人中的 938420 人（49.8%），苏格兰 4992498 人中的 1709786 人（34.2%），威尔士 2358740 人中的 773850 人（32.8%）。年龄较小、来自贫困背景、非白种人或合并症较少的人更不可能完全接种疫苗。共有 40393 例 COVID-19 重症结局，其中 14156 例发生在未完全接种的参与者中。我们估计在 4 个月的随访中，假设 2022 年 6 月 1 日每个人都完全接种疫苗，与 COVID-19 重症结局相关的减少量在 5-15 岁年龄组为 210（95%CI 94-326），16-74 岁年龄组为 1544（1399-1689），75 岁及以上年龄组为 5426（5340-5512）。荟萃分析中 75 岁及以上年龄组 COVID-19 重症结局的 aHR 为 1 剂少于推荐剂量的 2.70（2.61-2.78），2 剂少于推荐剂量的 3.13（2.93-3.34），3 剂少于推荐剂量的 3.61（3.13-4.17），4 剂少于推荐剂量的 3.08（2.89-3.29）。