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. 2025 Mar 7:49:126808.
doi: 10.1016/j.vaccine.2025.126808. Epub 2025 Jan 30.

Estimating COVID-19 associated hospitalizations, ICU admissions, and in-hospital deaths averted in the United States by 2023-2024 COVID-19 vaccination: A conditional probability, causal inference, and multiplier-based approach

Ryan E Wiegand  1 , Owen Devine  2 , Megan Wallace  2 , Ismael R Ortega-Sanchez  2 , Huong T Pham  2 , Diba Khan  2 , Danielle L Moulia  2 , Lauren E Roper  2 , Imelda Trejo  3 , Katherine E Fleming-Dutra  2 , Fiona P Havers  2 , Christopher A Taylor  2
Affiliations

Estimating COVID-19 associated hospitalizations, ICU admissions, and in-hospital deaths averted in the United States by 2023-2024 COVID-19 vaccination: A conditional probability, causal inference, and multiplier-based approach

Ryan E Wiegand et al. Vaccine. .

Abstract

COVID-19-associated hospitalizations, ICU admissions, and in-hospital deaths averted from 2023 to 2024 COVID-19 vaccination from the weeks of October 1, 2023, through April 21, 2024, were estimated via a novel multiplier model that utilized causal inference, conditional probabilities of hospitalization, and correlations between data elements in Monte Carlo simulations. Median COVID-19-associated hospitalizations averted were 68,315 (95 % uncertainty interval [UI] 42,831-97,984), ICU admissions averted were 13,108 (95 % UI 4459-25,042), and in-hospital deaths averted were 5301 (95 % UI 101-14,230). Averted COVID-19-associated burden was highest in adults aged 65 years and older (hospitalizations averted 57,665, 95 % UI 35,442-84,006; ICU admissions averted 10,878, 95 % UI 3104-21,591; in-hospital deaths averted 4779, 95 % UI 0-13,132). Expanding the analytic period to comprise the weeks of September 24, 2023, through August 11, 2024, resulted in 107,197 COVID-19-associated hospitalizations averted (95 % UI 80,692-137,643), 18,292 COVID-19-associated ICU admissions averted (95 % UI 10,062-28,436), and 6749 COVID-19-associated in-hospital deaths averted (95 % UI 2077-13,557). Older adults had the highest COVID-19-associated averted burden and potential to reduce burden further through increased vaccine coverage. 2023-2024 COVID-19 vaccinations reduced the burden of COVID-19-associated severe disease.

Keywords: COVID-19; disease burden; epidemiological models; vaccines.

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Conflict of interest statement

Declaration of competing interest 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

Figure 1:
Figure 1:
Categories of the U.S. population by 2023-2024 COVID-19 vaccination status in factual and assumptions made in the counterfactual scenario.
Figure 2:
Figure 2:
Seasonal and annual estimates of COVID-19-associated hospitalizations and hospitalizations averted by 2023-2024 COVID-19 vaccination, United States. Error bars represent 95% uncertainty intervals for COVID-19-associated hospitalizations averted calculated from Bayesian random effects model and Monte Carlo simulations. Seasonal estimates include the weeks of October 1, 2023, through April 21, 2024, and annual estimates include the weeks of September 24, 2023, through August 11, 2024. †Cumulative 2023-2024 COVID-19 vaccination coverage is through the week of April 21, 2024, for seasonal and through May 5, 2024, for annual. *Based on having at least one dose of 2023-2024 COVID-19 vaccination. ‡Coverage is in people aged 18+ years.
Figure 3:
Figure 3:
Seasonal and annual estimates of COVID-19-associated ICU admissions and ICU admissions averted by 2023-2024 COVID-19 vaccination, United States. Error bars represent 95% uncertainty intervals for COVID-19-associated ICU admissions averted that are calculated from Bayesian random effects model and Monte Carlo simulations. Seasonal estimates include the weeks of October 1, 2023, through April 21, 2024, and annual estimates include the weeks of September 24, 2023, through August 11, 2024. †Cumulative 2023-2024 COVID-19 vaccination coverage is through the week of April 21, 2024, for seasonal and through May 5, 2024, for annual. *Based on having at least one dose of 2023-2024 COVID-19 vaccination. ‡Coverage is in people aged 18+ years.
Figure 4:
Figure 4:
Seasonal and annual estimates of COVID-19-associated in-hospital deaths and in-hospital deaths averted by 2023-2024 COVID-19 vaccination, United States. Error bars represent 95% uncertainty intervals for COVID-19-associated in-hospital deaths averted that are calculated from Bayesian random effects model and Monte Carlo simulations. Seasonal estimates include the weeks of October 1, 2023, through April 21, 2024, and annual estimates include the weeks of September 24, 2023, through August 11, 2024. †Cumulative 2023-2024 COVID-19 vaccination coverage is through the week of April 21, 2024, for seasonal and through May 5, 2024, for annual. *Based on having at least one dose of 2023-2024 COVID-19 vaccination. ‡Coverage is in people aged 18+ years.
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