Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

Jain, Abhishek; Walker, Jemma; Mathur, Rohini; Forbes, Harriet; Langan, Sinéad; Smeeth, Liam; Hoek, Albert Jan van; Thomas, Sara L

doi:10.1371/journal.pone.0207183

Cited by 17 publications

(25 citation statements)

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“…To our knowledge this manuscript, an update of our January 27th preprint covering only OpenSAFELY-TPP patients (40% of the population), is the first study to describe in detail the demographic and clinical features of those who have been vaccinated by the NHS England COVID-19 vaccination campaign; and the only study to report on variation in vaccination by fine-grained clinical characteristics, because OpenSAFELY can provide detailed information about the demographics and clinical conditions of those vaccinated from each patients’ full pseudonymised EHR, which is not available within NIMS. Our finding of lower vaccination coverage in black and asian groups is concerning: it is also consistent with previous research on variation in vaccine coverage between ethnic groups during other vaccination campaigns historically [22–24], and with survey data on intention to accept the COVID-19 vaccine. [25–28].…”

Section: Discussionsupporting

confidence: 91%

“…This is because OpenSAFELY-TPP can provide detailed information about the demographics and clinical conditions of those vaccinated which is not available within NIMS. Our finding of discrepancies between ethnic groups is concerning: it requires action, and further investigation; possible drivers include systematic barriers to healthcare access, and vaccine hesitancy amongst certain groups [19,20,21, 22–24, 25]; it may also only arise in the very earliest stages of this new vaccination programme.…”

Section: Discussionmentioning

confidence: 99%

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Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Curtis

Inglesby

Morton

et al. 2021

Preprint

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BackgroundOn December 8th 2020, NHS England administered the first COVID-19 vaccination as part of an ambitious vaccination programme during a global health emergency.AimsTo develop a framework for detailed near-real-time monitoring of COVID-19 vaccine roll-out; to describe trends and variation in coverage by geographic area, and between key clinical and demographic patient groups.MethodsWorking on behalf of NHS England we used routine clinical data from 23.4 million patients to conduct a retrospective cohort study of comprehensive electronic health record data in NHS England, using the OpenSAFELY-TPP platform which covers approximately 40% of the general population in England with weekly data updates. We developed algorithms to identify key demographic and clinical sub-groups within this population and generated descriptive statistics on proportion of eligible patients receiving the vaccine among key Joint Committee on Vaccination and Immunisation (JCVI) target groups.ResultsBetween December 8th and January 13th 961,580 people out of 23.4m in our dataset received a COVID-19 vaccine. Of 1,160,062 patients aged 80 or over and not living in a care home (currently targeted by JCVI) 476,375 had been vaccinated in total (41.1%). We observed a substantial divergence in vaccination by ethnicity within this group (White 42.5% vaccinated, Black 20.5%) and across rankings of deprivation (least deprived 44.7%, most deprived 37.9%). Patients with pre-existing medical conditions were equally likely, or more likely, to have received a vaccine across most co-morbidity groups with two exceptions: severe mental illness (30.3% vaccinated) and learning disability (28.1%). We identify substantial variation in vaccination among the over-80s between Sustainability and Transformation Partnerships (STPs; Range 12%-74%); lower vaccination rates among ethnic minority and deprived groups was observed in most but not all STPs. In the 70-79 age cohort 74,108 people (3.6%) had been vaccinated. 378,921 vaccine recipients under 70 and not identifiably resident in a care home were presumed to be health or social care workers; 32,174 recipients were identified as older aged care home residents (33.2% coverage). Of all those vaccinated, 169,472 had received a second dose (17.6%).ConclusionsThe NHS in England has rapidly delivered mass vaccination. We were able to deploy a data monitoring framework across small clinical subgroups using linked patient-level NHS data on 23.4 million people with very short delays from vaccine administration to completed analysis. Targeted activity may be needed to address lower vaccination rates observed among certain key groups: ethnic minorities, people living in areas of higher deprivation, and those with severe mental illness or learning disabilities. However we note that this data is only from the first preliminary weeks of the vaccination programme. Variation in vaccination coverage between groups and regions will have many complex drivers, the figures presented in this manuscript require thoughtful interpretation to support a rapidly evolving NHS vaccination campaign; we are sharing local level data with national and regional NHS teams on request.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Curtis

Inglesby

Morton

et al. 2021

Preprint

Self Cite

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“…Our finding of higher rates of declines being recorded in Black and South Asian groups is generally consistent with survey data on intention to accept the COVID-19 vaccine (Parveen, Mohdin, and McIntyre 2021;Robinson, Jones, and Daly 2020;Allington et al 2021;Royal Society of Public Health 2020;Robertson et al 2021), and with previous research on variation in vaccine coverage in other vaccination campaigns historically (Ward et al 2017;Loiacono et al 2020;Jain et al 2018).…”

Section: Findings In Contextsupporting

confidence: 90%

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

Curtis

Inglesby

MacKenna

et al. 2021

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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.

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“…For each vaccine, a complete case analysis (excluding women with no ethnicity recorded in the main analysis) using multivariable logistic regression was used to estimate associations between vaccine uptake and social determinants. Our modelling strategy followed a previously adapted version 33 of a conceptual framework to analyse the hierarchical inter-relationships between distal and proximate social determinants with vaccine uptake ( online supplemental file 1 ). 34 We first fitted a ‘minimally adjusted’ model to estimate associations between each social determinant and vaccine uptake adjusted for year (calendar year for pertussis, financial year for influenza to reflect the influenza season) to adjust for secular trends as an a priori confounder.…”

Section: Methodsmentioning

confidence: 99%

Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records

et al. 2021

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ObjectiveTo examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England.DesignNationwide population-based cohort study.SettingThe study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data.ParticipantsPregnant women eligible for pertussis (2012–2015, n=68 090) or influenza (2010/2011–2015/2016, n=152 132) vaccination in England.Main outcome measuresInfluenza and pertussis vaccine uptake.ResultsVaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy.ConclusionsTargeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.

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Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink

Cited by 17 publications

References 35 publications

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

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

Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records

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