Recording of “COVID-19 vaccine declined” among vaccination priority groups: a cohort study on 57.9 million NHS patients’ primary care records in situ using OpenSAFELY

Abstract

BackgroundAll patients in England within vaccine priority groups were offered a COVID-19 vaccine by mid-April 2021. Clinical record systems contain codes to denote when such an offer has been declined by a patient (although these can in some cases be entered for a variety of other reasons including vaccination delay, or other administrative issues). We set out to describe the patterns of usage of codes for COVID-19 vaccines being declined.MethodsWith the approval of NHS England and using the full pseudonymised primary care records for 57.9 million NHS patients, we identified all patients in key vaccine priority groups: aged over 50, or over 16 and at increased risk from COVID-19 (Clinically Extremely Vulnerable [CEV] or otherwise “at risk”). We describe the proportion of patients recorded as declining a COVID-19 vaccination for each priority group, and by other clinical and demographic factors; whether patients recorded as “declined” subsequently went on to receive a vaccination; and the distribution of code usage across GP practices.ResultsOf 24.5 million patients in priority groups as of May 25th 2021, 89.2% had received a vaccine, 8.8% had neither a vaccination nor a decline recorded, and 663,033 (2.7%) had a decline code recorded. Of patients with a recorded decline, 125,587 (18.9%) were subsequently vaccinated. Subsequent vaccination was slightly more common in the South Asian population than other ethnicities (e.g. 32.3% vs 22.8%, over 65s). The proportion of declining-unvaccinated patients varied strongly with ethnicity (Black 15.3%, South Asian 5.6%, White 1.5% in over 80s); and was higher in patients from more deprived areas. COVID-19 vaccine decline codes were present in almost all practices (98.8%), but with wide variation between practices in rates of usage. Among all priority groups, declining-unvaccinated status was most common in CEV (3.3%).ConclusionsClinical codes indicative of COVID-19 vaccinations being declined are widely used in English general practice. They are substantially more common among Black and South Asian patients, and patients from more deprived areas. There is a need for more detailed survey and/or qualitative research with patients and clinicians to determine the most common reasons for these recorded declines.

OpenSAFELY: Representativeness of Electronic Health Record platform OpenSAFELY-TPP data compared to the population of England

“…However, OpenSAFELY is now also implemented in the data analysis environment of EMIS, a primary care electronic health record system supplier covering 55% of all practices in England. In addition, OpenSAFELY also supports federated analytics, where the same data preparation and analysis code is sent to OpenSAFELY-TPP and OpenSAFELY-EMIS to execute the same curation and analysis in each setting, with the results then combined into a single analysis, with a variety of papers already published using this approach (1)(2)(3)(4)(5). Nonetheless in the future it may still be more convenient or proportionate to execute analyses only in OpenSAFELY-TPP; therefore the high degree of representativeness demonstrated in this paper provides strong reassurance that such analyses present no interpretive or generalisability challenges.…”

“…To date more than 20 publications have used the OpenSAFELY platform, focused on delivering vital and urgent results related to the global COVID-19 emergency. Some of these papers have used the federated analytics functionality more latterly available in OpenSAFELY to deliver combined analyses across 58 million patients' data in both OpenSAFELY-EMIS and OpenSAFELY-TPP (1)(2)(3)(4)(5); however the majority of analyses published during the pandemic specifically used OpenSAFELY-TPP which covers 40% of general practices in England, those using SystmOne Electronic Health Record (EHR) software produced by TPP.…”

The Role of Sudanese Doctors in the United Kingdom in Mitigating COVID-19 Vaccine Hesitancy Among Their Diaspora Communities

“… 4 Despite consideration by the government, vaccine hesitancy prevailed among ethnic minorities, resulting in inferior enrollment rates. 5 , 6 A large UK study revealed a stark disparity in vaccine uptake, with 68.3% of Black groups accepting a COVID-19 vaccine compared to 96.2% of the White population. 3 A constellation of factors related to social, religious, epistemic, and policymaking uncertainties has likely contributed to the complexity of this issue.…”