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

Abstract

Background: On 8 December 2020 NHS England administered the first COVID-19 vaccination.

Aim: To describe trends and variation in vaccine coverage in different clinical and demographic groups in the first 100 days of the vaccine rollout.

Design and setting: With the approval of NHS England, a cohort study was conducted of 57.9 million patient records in general practice in England, in situ and within the infrastructure of the electronic health record software vendors EMIS and TPP using OpenSAFELY.

Method: Vaccine coverage across various subgroups of Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts is described.

Results: A total of 20 852 692 patients (36.0%) received a vaccine between 8 December 2020 and 17 March 2021. Of patients aged ≥80 years not in a care home (JCVI group 2) 94.7% received a vaccine, but with substantial variation by ethnicity (White 96.2%, Black 68.3%) and deprivation (least deprived 96.6%, most deprived 90.7%). Patients with pre-existing medical conditions were more likely to be vaccinated with two exceptions: severe mental illness (89.5%) and learning disability (91.4%). There were 275 205 vaccine recipients who were identified as care home residents (JCVI group 1; 91.2% coverage). By 17 March, 1 257 914 (6.0%) recipients had a second dose.

Conclusion: The NHS rapidly delivered mass vaccination. In this study a data-monitoring framework was deployed using publicly auditable methods and a secure in situ processing model, using linked but pseudonymised patient-level NHS data for 57.9 million patients. Targeted activity may be needed to address lower vaccination coverage observed among certain key groups.

Keywords: COVID-19; NHS England; SARS-CoV-2; ethnic groups; general practice; vaccination.

Figure 1.

a) Cumulative daily total number of patients (millions) in England receiving at least one vaccination recorded in OpenSAFELY on 17 March 2021; across the whole population (All) and split according to whether patients were known to be part of a priority group or not (excluding occupational eligibility). b) Cumulative daily proportion (%) of patients receiving at least one COVID vaccine dose by Joint Committee on Vaccination and Immunisation priority groups (excluding occupational eligibility) in England recorded in OpenSAFELY on 17 March 2021. CEV = clinically extremely vulnerable.

Figure 2.

Cumulative trends in demographic features of the 80 years and older population receiving their first COVID vaccination. a) COVID vaccinations among the age 80 years and over population by Index of Multiple Deprivation. b) COVID vaccinations among the age 80 years and over population by ethnicity (broad categories). IMD = Index of Multiple Deprivation.

Figure 3.

Cumulative trends in clinical characteristics of priority group 2 (age 80 years and over population and not resident in a care home) receiving their first COVID vaccination. a) COVID vaccinations among the age 80 years and over population by ‘morbid obesity’. b) COVID vaccinations among the age 80 years and over population by ‘chronic respiratory disease’. c) COVID vaccinations among the age 80 years and over population by ‘severe mental illness’. d) COVID vaccinations among the age 80 years and over population by ‘learning disability’.

Figure 4.

Estimated hazard ratios (HR) for each potential risk factor from a multivariable Cox model, stratified by GP practice. All HRs are adjusted for all other factors listed. IMD = Index of Multiple Deprivation.