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. 2022 Aug;27(33):2100885.
doi: 10.2807/1560-7917.ES.2022.27.33.2100885.

Recording of 'COVID-19 vaccine declined': a cohort study on 57.9 million National Health Service patients' records in situ using OpenSAFELY, England, 8 December 2020 to 25 May 2021

Helen J Curtis  1 , Peter Inglesby  1 , Brian MacKenna  1 , Richard Croker  1 , William J Hulme  1 , Christopher T Rentsch  2 , Krishnan Bhaskaran  2 , Rohini Mathur  2 , Caroline E Morton  1 , Sebastian Cj Bacon  1 , Rebecca M Smith  1 , David Evans  1 , Amir Mehrkar  1 , Laurie Tomlinson  2 , Alex J Walker  1 , Christopher Bates  3 , George Hickman  1 , Tom Ward  1 , Jessica Morley  1 , Jonathan Cockburn  3 , Simon Davy  1 , Elizabeth J Williamson  2 , Rosalind M Eggo  2 , John Parry  3 , Frank Hester  3 , Sam Harper  3 , Shaun O'Hanlon  4 , Alex Eavis  4 , Richard Jarvis  4 , Dima Avramov  4 , Paul Griffiths  4 , Aaron Fowles  4 , Nasreen Parkes  4 , Stephen Jw Evans  2 , Ian J Douglas  2 , Liam Smeeth  2 , Ben Goldacre  1
Affiliations

Recording of 'COVID-19 vaccine declined': a cohort study on 57.9 million National Health Service patients' records in situ using OpenSAFELY, England, 8 December 2020 to 25 May 2021

Helen J Curtis et al. Euro Surveill. 2022 Aug.

Abstract

BackgroundPriority patients in England were offered COVID-19 vaccination by mid-April 2021. Codes in clinical record systems can denote the vaccine being declined.AimWe describe records of COVID-19 vaccines being declined, according to clinical and demographic factors.MethodsWith the approval of NHS England, we conducted a retrospective cohort study between 8 December 2020 and 25 May 2021 with primary care records for 57.9 million patients using OpenSAFELY, a secure health analytics platform. COVID-19 vaccination priority patients were those aged ≥ 50 years or ≥ 16 years clinically extremely vulnerable (CEV) or 'at risk'. We describe the proportion recorded as declining vaccination for each group and stratified by clinical and demographic subgroups, subsequent vaccination and distribution of clinical code usage across general practices.ResultsOf 24.5 million priority patients, 663,033 (2.7%) had a decline recorded, while 2,155,076 (8.8%) had neither a vaccine nor decline recorded. Those recorded as declining, who were subsequently vaccinated (n = 125,587; 18.9%) were overrepresented in the South Asian population (32.3% vs 22.8% for other ethnicities aged ≥ 65 years). The proportion of declining unvaccinated patients was highest in CEV (3.3%), varied strongly with ethnicity (black 15.3%, South Asian 5.6%, white 1.5% for ≥ 80 years) and correlated positively with increasing deprivation.ConclusionsClinical codes indicative of COVID-19 vaccinations being declined are commonly used in England, but substantially more common among black and South Asian people, and in more deprived areas. Qualitative research is needed to determine typical reasons for recorded declines, including to what extent they reflect patients actively declining.

Keywords: COVID-19; NHS England; SARS-CoV-2; vaccination; vaccine hesitancy.

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Conflict of interest statement

Conflict of interest: Authors declare the following: over the past five years BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he also receives personal income from speaking and writing for lay audiences on the misuse of science. KB holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). EJW holds grants from MRC. RM holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (201375/Z/16/Z). IJD has received unrestricted research grants and holds shares in GlaxoSmithKline (GSK).

Figures

Figure 1
Figure 1
Recorded COVID-19 vaccination status of patients in OpenSAFELY, England, 8 December 2020–25 May 2021 (n = 24,476,809)
Figure 2
Figure 2
Percentage of patients who had a COVID-19 vaccination decline recorded and were unvaccinated in OpenSAFELY by priority group, England, as per 25 May 2021 (n = 483,791)
Figure 3
Figure 3
COVID-19 vaccination status recorded for patients in OpenSAFELY for three combined priority groups split by broad ethnic groups, England, as per 25 May 2021 (n = 24,476,809)
Figure 4
Figure 4
Patients in each priority group who were later vaccinated, after previously being recorded as declining a COVID-19 vaccine, England, as per 25 May 2021 (n = 125,587)
Figure 5
Figure 5
Histograms showing variation in the number of patients in priority groups per practice recorded as declining a COVID-19 vaccination, England, as per 25 May 2021 (n = 663,033)
See this image and copyright information in PMC

References

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    1. OpenSAFELY. About OpenSAFELY. Oxford. Accessed: 21 Jun 2021]. Available from: https:// https://www.opensafely.org/about/ /

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