Factors associated with COVID-19 vaccine uptake in people with kidney disease: an OpenSAFELY cohort study

Abstract

Objective: To characterise factors associated with COVID-19 vaccine uptake among people with kidney disease in England.

Design: Retrospective cohort study using the OpenSAFELY-TPP platform, performed with the approval of NHS England.

Setting: Individual-level routine clinical data from 24 million people across GPs in England using TPP software. Primary care data were linked directly with COVID-19 vaccine records up to 31 August 2022 and with renal replacement therapy (RRT) status via the UK Renal Registry (UKRR).

Participants: A cohort of adults with stage 3-5 chronic kidney disease (CKD) or receiving RRT at the start of the COVID-19 vaccine roll-out was identified based on evidence of reduced estimated glomerular filtration rate (eGFR) or inclusion in the UKRR.

Main outcome measures: Dose-specific vaccine coverage over time was determined from 1 December 2020 to 31 August 2022. Individual-level factors associated with receipt of a 3-dose or 4-dose vaccine series were explored via Cox proportional hazards models.

Results: 992 205 people with stage 3-5 CKD or receiving RRT were included. Cumulative vaccine coverage as of 31 August 2022 was 97.5%, 97.0% and 93.9% for doses 1, 2 and 3, respectively, and 81.9% for dose 4 among individuals with one or more indications for eligibility. Delayed 3-dose vaccine uptake was associated with younger age, minority ethnicity, social deprivation and severe mental illness-associations that were consistent across CKD severity subgroups, dialysis patients and kidney transplant recipients. Similar associations were observed for 4-dose uptake.

Conclusion: Although high primary vaccine and booster dose coverage has been achieved among people with kidney disease in England, key disparities in vaccine uptake remain across clinical and demographic groups and 4-dose coverage is suboptimal. Targeted interventions are needed to identify barriers to vaccine uptake among under-vaccinated subgroups identified in the present study.

Keywords: COVID-19; Kidney & urinary tract disorders; Public health.

Figure 1

Dose-specific coverage and product profile among people with kidney disease. (A) Cumulative dose-specific vaccine coverage over time. Cumulative coverage was determined based on Kaplan-Meier estimates for the receipt of any combination of vaccine products, censoring at death, deregistration or 31 August 2022. For dose 4, we report overall coverage (dashed line) and coverage among the subset of the cohort with at least one indicator for receipt of a fourth dose (3 primary+1 booster or 2 primary+2 boosters; dotted line). (B) Vaccine product distribution by dose.

Figure 2

Factors associated with completion of a 3-dose vaccine series in people with kidney disease. The left-hand panels display hazard ratios and 95% CIs from partially adjusted models that included age, care home residence, health and social care worker status, housebound status, receipt of end-of-life care, setting (urban/rural), sex, ethnicity, IMD quintile, prior SARS-CoV-2 infection, immunosuppression and haematologic cancer. CIs are generally too narrow to be visible. See online supplemental table 2 for minimally and fully adjusted model outputs. The right-hand panels display the cumulative coverage based on Kaplan-Meier estimates, censoring at death, deregistration or 31 August 2022. CKD, chronic kidney disease; IMD, index of multiple deprivation; RRT, renal replacement therapy.

Figure 3

Cumulative 3-dose and 4-dose coverage in subgroups defined by deprivation index, ethnicity, age and kidney disease severity. Cumulative coverage was determined based on Kaplan-Meier estimates, censoring at death, deregistration or 31 August 2022. Minority ethnic groups are combined due to their low combined prevalence within the study population. See online supplemental tables 4 and 8 for complete data. CKD, chronic kidney disease; IMD, index of multiple deprivation quintile; RRT, renal replacement therapy; Tx, transplant.