Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2026 Jan 3;27(1):37.
doi: 10.1186/s12931-025-03470-9.

Effect of COVID-19 vaccination and SARS-CoV-2 infection status on mortality risk in patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study

Sang Hyuk Kim #  1 , Jong Seung Kim #  2   3   4 , Min Gu Kang #  3   4 , Min Ji Kim  3   4 , Dong-Woo Han  5 , Youlim Kim  6 , Kyung Hoon Min  1 , Sang-Heon Kim  5 , Jang Won Sohn  5 , Kwang Ha Yoo  6 , Ho Joo Yoon  5 , Ji-Yong Moon #  7 , Hyun Lee #  8
Affiliations

Effect of COVID-19 vaccination and SARS-CoV-2 infection status on mortality risk in patients with chronic obstructive pulmonary disease: a nationwide population-based cohort study

Sang Hyuk Kim et al. Respir Res. .

Abstract

Background: The coronavirus disease 2019 (COVID-19) vaccination is suggested to be effective in improving outcomes of chronic obstructive pulmonary disease (COPD). However, real-world evidence on long-term mortality among individuals with COPD, accounting for both vaccination and COVID-19 infection status, remains sparse.

Methods: A retrospective cohort study was conducted using datasets from the Korean National Health Insurance system. Through two-step propensity score matching, 716 individuals with COPD were included in the analysis and classified into four groups according to COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 infection status: 125 COVID-19 vaccinated/uninfected, 125 vaccinated/infected, 233 unvaccinated/uninfected, and 233 unvaccinated/infected. A multivariable Cox proportional hazards regression analysis was conducted to assess the risk of mortality following COVID-19 vaccination and SARS-CoV-2 infection status.

Results: The median follow-up period was 420 days, during which 79.6% of study participants completed follow-up. Mortality rates were lowest in the vaccinated/uninfected individuals (281/10,000 person-years), followed by the vaccinated/infected individuals (661/10,000 person-years) and unvaccinated/uninfected individuals (2,106/10,000 person-years) and highest in unvaccinated/infected individuals (4,510/10,000 person-years). Compared with vaccinated/uninfected individuals, unvaccinated/infected individuals had a significantly higher annual risk of mortality (adjusted hazard ratio [aHR] = 13.51, 95% confidence interval [CI] = 4.91–37.13). The annual mortality risk was also significantly higher among unvaccinated/uninfected individuals (aHR = 6.01, 95% CI = 2.15–16.81). On the other hand, vaccinated/infected individuals (aHR = 2.32, 95% CI = 0.71–7.55) did not exhibit a significantly increased annual mortality risk compared with vaccinated/uninfected individuals.

Conclusion: COVID-19 vaccination is associated with reduced long-term COPD-related mortality, whereas mortality risk was higher in unvaccinated/uninfected individuals than in vaccinated/infected individuals. Vaccination-related factors may confer broader benefits on COPD outcomes beyond direct protection against COVID-19.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12931-025-03470-9.

Keywords: COVID-19; Chronic obstructive pulmonary disease; Mortality; Respiratory disease; Vaccination.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Institutional Review Board of Hanyang University Hospital (No. HYUH-2024-10-002). The requirement for informed consent was waived because all patient records were anonymized before use. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population. Abbreviations: COPD = chronic obstructive pulmonary disease, COVID-19 = coronavirus disease 2019, PS = propensity score
Fig. 2
Fig. 2
Kaplan-Meier curve for mortality based on COVID-19 vaccination and infection statuses. Abbreviations: COVID-19 = coronavirus disease 2019
Fig. 3
Fig. 3
Kaplan-Meier curve for mortality among severe COVID-19 cases. Abbreviations: COVID-19 = coronavirus disease 2019, aHR = adjusted hazard ratio, CI = confidence interval
See this image and copyright information in PMC

References

    1. Contreras S, Iftekhar EN, Priesemann V. From emergency response to long-term management: the many faces of the endemic state of COVID-19. Lancet Reg Health Eur. 2023;30:100664. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention. People with certain medical conditions and COVID-19 risk factors. https://www.cdc.gov/covid/risk-factors/index.html . Accessed 24 Aug 2024.
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for Prevention, diagnosis and management of COPD: 2024 Report. Updated 2024. http://goldcopd.org/2024-gold-report . Assess 27 July 2024.
    1. Centers for Disease Control and Prevention. Recommendations for the use of COVID-19 vaccines. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-co... . Assessed 4 Aug 2024.
    1. Korea Academy of Tuberculosis and Respiratory Disease. Korean Chronic Obstructive Lung Disease Guideline 2024. https://www.lungkorea.org/bbs/index.html?code=guide&category=&gubun=&pag... . Assessed 12 Oct 2025.

LinkOut - more resources