Study Identifies Groups Still At Risk of Severe COVID Despite Vaccination

Peter Russell

September 18, 2021

Editor's note, 23 September 2021: The title of this article was amended for clarity.

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

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

The researchers used the QCovid tool to analyse outcomes in adults aged 19 and over between December 8 last year and June 15 this year.

They used national linked datasets from general practice, national immunisation, and SARS-CoV-2 testing, death registry, and hospital episode data, in order to analyse a sample of more than 6.9m 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 or more days after the second vaccine dose.

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

New Tool 'Will Help Identify Risk Factors'

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

The study, published in The BMJ, found that incidence of mortality from COVID-19 increased with age, deprivation, being male, and for those with Indian and Pakistaniethnicity.

Best Clinical Research Data in the World. 

Prof Julia Hippisley-Cox/SMC

Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Oxford, 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 a 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."

Prof 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."

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2244 (Published 17 September 2021)

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