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. 2022 Apr:10:100134.
doi: 10.1016/j.jvacx.2021.100134. Epub 2021 Dec 22.

Reduced COVID-19 hospitalizations among New York City residents following age-based SARS-CoV-2 vaccine eligibility: Evidence from a regression discontinuity design

Sharon K Greene  1 , Alison Levin-Rector  1 , Emily McGibbon  1 , Jennifer Baumgartner  1 , Katelynn Devinney  1 , Alexandra Ternier  2 , Jessica Sell  1 , Rebecca Kahn  3 , Nishant Kishore  3
Affiliations

Reduced COVID-19 hospitalizations among New York City residents following age-based SARS-CoV-2 vaccine eligibility: Evidence from a regression discontinuity design

Sharon K Greene et al. Vaccine X. 2022 Apr.

Abstract

Background: In clinical trials, several SARS-CoV-2 vaccines were shown to reduce risk of severe COVID-19 illness. Local, population-level, real-world evidence of vaccine effectiveness is accumulating. We assessed vaccine effectiveness for community-dwelling New York City (NYC) residents using a quasi-experimental, regression discontinuity design, leveraging a period (January 12-March 9, 2021) when ≥ 65-year-olds were vaccine-eligible but younger persons, excluding essential workers, were not.

Methods: We constructed segmented, negative binomial regression models of age-specific COVID-19 hospitalization rates among 45-84-year-old NYC residents during a post-vaccination program implementation period (February 21-April 17, 2021), with a discontinuity at age 65 years. The relationship between age and hospitalization rates in an unvaccinated population was incorporated using a pre-implementation period (December 20, 2020-February 13, 2021). We calculated the rate ratio (RR) and 95% confidence interval (CI) for the interaction between implementation period (pre or post) and age-based eligibility (45-64 or 65-84 years). Analyses were stratified by race/ethnicity and borough of residence. Similar analyses were conducted for COVID-19 deaths.

Results: Hospitalization rates among 65-84-year-olds decreased from pre- to post-implementation periods (RR 0.85, 95% CI: 0.74-0.97), controlling for trends among 45-64-year-olds. Accordingly, an estimated 721 (95% CI: 126-1,241) hospitalizations were averted. Residents just above the eligibility threshold (65-66-year-olds) had lower hospitalization rates than those below (63-64-year-olds). Racial/ethnic groups and boroughs with higher vaccine coverage generally experienced greater reductions in RR point estimates. Uncertainty was greater for the decrease in COVID-19 death rates (RR 0.85, 95% CI: 0.66-1.10).

Conclusion: The vaccination program in NYC reduced COVID-19 hospitalizations among the initially age-eligible ≥ 65-year-old population by approximately 15% in the first eight weeks. The real-world evidence of vaccine effectiveness makes it more imperative to improve vaccine access and uptake to reduce inequities in COVID-19 outcomes.

Keywords: CI, confidence interval; COVID-19; COVID-19, coronavirus disease 2019; DOHMH, Department of Health and Mental Hygiene; Epidemiology; NYC, New York City; Public Health; RR, rate ratio; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Surveillance; Vaccines.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Weekly COVID-19 hospitalizations and cumulative vaccine coverage among 45–64 and 65–84-year-olds in relation to timing of age-based SARS-CoV-2 vaccine eligibility, New York City, December 13, 2020–April 17, 2021.
Fig. 2
Fig. 2
COVID-19 hospitalization rates among New York City residents by year of age during 8-week pre- (December 20, 2020–Feb 13, 2021) and post- (February 21–April 17, 2021) implementation periods for the SARS-CoV-2 vaccine program.
See this image and copyright information in PMC

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