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

Edward PK Parker; John Tazare; William J Hulme; Christopher Bates; Edward  Carr; Jonathan Cockburn; Helen J Curtis; Louis Fisher; Amelia Green; Sam Harper; Frank Hester; Elsie M F Horne; Fiona Loud; Susan Lyon; Viyaasan Mahalingasivam; Amir Mehrkar; Linda Nab; John S C Parry; Shalini Santhakumaran; Retha Steenkamp; Jonathan A C Sterne; Alex J Walker; Elizabeth J. Williamson; Michelle Willicombe; Bang Zheng; Ben  Goldacre; Dorothea Nitsch; Laurie Tomlinson

doi:10.1136/bmjopen-2022-066164

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

Edward PK Parker
, John Tazare
, William J Hulme
, Christopher Bates
, Edward Carr
, Jonathan Cockburn
, Helen J Curtis
, Louis Fisher
, Amelia Green
, Sam Harper
, Frank Hester
, Elsie M F Horne
, Fiona Loud
, Susan Lyon
, Viyaasan Mahalingasivam
, Amir Mehrkar
, Linda Nab
, John S C Parry
, Shalini Santhakumaran
, Retha Steenkamp

Jonathan A C Sterne, Alex J Walker, Elizabeth J. Williamson, Michelle Willicombe, Bang Zheng, Ben Goldacre , Dorothea Nitsch, Laurie Tomlinson^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

10 Citations (Scopus)

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.

Original language	English
Article number	e066164
Journal	BMJ Open
Volume	13
Issue number	1
DOIs	https://doi.org/10.1136/bmjopen-2022-066164
Publication status	Published - 31 Jan 2023

Bibliographical note

Funding Information:
BG’s work on better use of data in healthcare more broadly is currently funded in part by: the Bennett Foundation, the Wellcome Trust, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation; all Bennett Institute staff are supported by BG's grants on this work. BG is a Non-Executive Director at NHS Digital. EJW holds grants from MRC.

Funding Information:
This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1, MR/W021420/1); NIHR (NIHR135559, COV-LT2-0073) and Health Data Research UK (HDRUK2021.000, 2021.0157). EPKP received funding from the UKRI COVID-19 Longitudinal Health and Wellbeing National Core Study (Phase 1 LHW-NCS, MC_PC-20059) through a secondment scheme (MR/W021420/1). The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Publisher Copyright:
© 2023 Author(s). Published by BMJ.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Parker, E. PK., Tazare, J., Hulme, W. J., Bates, C., Carr, E., Cockburn, J., Curtis, H. J., Fisher, L., Green, A., Harper, S., Hester, F., Horne, E. M. F., Loud, F., Lyon, S., Mahalingasivam, V., Mehrkar, A., Nab, L., Parry, J. S. C., Santhakumaran, S., ... Tomlinson, L. (2023). Factors associated with COVID-19 vaccine uptake in people with kidney disease: an OpenSAFELY cohort study. BMJ Open, 13(1), Article e066164. https://doi.org/10.1136/bmjopen-2022-066164

@article{4fd1416e26f540d4a277a03e3db2b6ad,

title = "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.",

author = "Parker, \{Edward PK\} and John Tazare and Hulme, \{William J\} and Christopher Bates and Edward Carr and Jonathan Cockburn and Curtis, \{Helen J\} and Louis Fisher and Amelia Green and Sam Harper and Frank Hester and Horne, \{Elsie M F\} and Fiona Loud and Susan Lyon and Viyaasan Mahalingasivam and Amir Mehrkar and Linda Nab and Parry, \{John S C\} and Shalini Santhakumaran and Retha Steenkamp and Sterne, \{Jonathan A C\} and Walker, \{Alex J\} and Williamson, \{Elizabeth J.\} and Michelle Willicombe and Bang Zheng and Ben Goldacre and Dorothea Nitsch and Laurie Tomlinson",

note = "Funding Information: BG{\textquoteright}s work on better use of data in healthcare more broadly is currently funded in part by: the Bennett Foundation, the Wellcome Trust, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation; all Bennett Institute staff are supported by BG's grants on this work. BG is a Non-Executive Director at NHS Digital. EJW holds grants from MRC. Funding Information: This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC\_PC-20059, MR/W016729/1, MR/W021420/1); NIHR (NIHR135559, COV-LT2-0073) and Health Data Research UK (HDRUK2021.000, 2021.0157). EPKP received funding from the UKRI COVID-19 Longitudinal Health and Wellbeing National Core Study (Phase 1 LHW-NCS, MC\_PC-20059) through a secondment scheme (MR/W021420/1). The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2023 Author(s). Published by BMJ.",

year = "2023",

month = jan,

day = "31",

doi = "10.1136/bmjopen-2022-066164",

language = "English",

volume = "13",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "1",

}

Parker, EPK, Tazare, J, Hulme, WJ, Bates, C, Carr, E, Cockburn, J, Curtis, HJ, Fisher, L, Green, A, Harper, S, Hester, F, Horne, EMF, Loud, F, Lyon, S, Mahalingasivam, V, Mehrkar, A, Nab, L, Parry, JSC, Santhakumaran, S, Steenkamp, R, Sterne, JAC, Walker, AJ, Williamson, EJ, Willicombe, M, Zheng, B, Goldacre , B, Nitsch, D & Tomlinson, L 2023, 'Factors associated with COVID-19 vaccine uptake in people with kidney disease: an OpenSAFELY cohort study', BMJ Open, vol. 13, no. 1, e066164. https://doi.org/10.1136/bmjopen-2022-066164

TY - JOUR

T1 - Factors associated with COVID-19 vaccine uptake in people with kidney disease

T2 - an OpenSAFELY cohort study

AU - Parker, Edward PK

AU - Tazare, John

AU - Hulme, William J

AU - Bates, Christopher

AU - Carr, Edward

AU - Cockburn, Jonathan

AU - Curtis, Helen J

AU - Fisher, Louis

AU - Green, Amelia

AU - Harper, Sam

AU - Hester, Frank

AU - Horne, Elsie M F

AU - Loud, Fiona

AU - Lyon, Susan

AU - Mahalingasivam, Viyaasan

AU - Mehrkar, Amir

AU - Nab, Linda

AU - Parry, John S C

AU - Santhakumaran, Shalini

AU - Steenkamp, Retha

AU - Sterne, Jonathan A C

AU - Walker, Alex J

AU - Williamson, Elizabeth J.

AU - Willicombe, Michelle

AU - Zheng, Bang

AU - Goldacre , Ben

AU - Nitsch, Dorothea

AU - Tomlinson, Laurie

N1 - Funding Information: BG’s work on better use of data in healthcare more broadly is currently funded in part by: the Bennett Foundation, the Wellcome Trust, NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation; all Bennett Institute staff are supported by BG's grants on this work. BG is a Non-Executive Director at NHS Digital. EJW holds grants from MRC. Funding Information: This work was jointly funded by the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1, MR/W021420/1); NIHR (NIHR135559, COV-LT2-0073) and Health Data Research UK (HDRUK2021.000, 2021.0157). EPKP received funding from the UKRI COVID-19 Longitudinal Health and Wellbeing National Core Study (Phase 1 LHW-NCS, MC_PC-20059) through a secondment scheme (MR/W021420/1). The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Publisher Copyright: © 2023 Author(s). Published by BMJ.

PY - 2023/1/31

Y1 - 2023/1/31

N2 - 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.

AB - 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.

U2 - 10.1136/bmjopen-2022-066164

DO - 10.1136/bmjopen-2022-066164

M3 - Article (Academic Journal)

C2 - 36720568

SN - 2044-6055

VL - 13

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e066164

ER -

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

Abstract

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