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Abstract

Background

Priority patients in England were offered COVID-19 vaccination by mid-April 2021. Codes in clinical record systems can denote the vaccine being declined.

Aim

We describe records of COVID-19 vaccines being declined, according to clinical and demographic factors.

Methods

With 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.

Results

Of 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.

Conclusions

Clinical 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.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
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2022-08-18
2024-12-22
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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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Helen+J+Curtis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Curtis Helen J</a>, <a href="/search?value1=Peter+Inglesby&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Inglesby Peter</a>, <a href="/search?value1=Brian+MacKenna&option1=author&noRedirect=true" class="nonDisambigAuthorLink">MacKenna Brian</a>, <a href="/search?value1=Richard+Croker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Croker Richard</a>, <a href="/search?value1=William+J+Hulme&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hulme William J</a>, <a href="/search?value1=Christopher+T+Rentsch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rentsch Christopher T</a>, <a href="/search?value1=Krishnan+Bhaskaran&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bhaskaran Krishnan</a>, <a href="/search?value1=Rohini+Mathur&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mathur Rohini</a>, <a href="/search?value1=Caroline+E+Morton&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Morton Caroline E</a>, <a href="/search?value1=Sebastian+CJ+Bacon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bacon Sebastian CJ</a>, <a href="/search?value1=Rebecca+M+Smith&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Smith Rebecca M</a>, <a href="/search?value1=David+Evans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Evans David</a>, <a href="/search?value1=Amir+Mehrkar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mehrkar Amir</a>, <a href="/search?value1=Laurie+Tomlinson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tomlinson Laurie</a>, <a href="/search?value1=Alex+J+Walker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Walker Alex J</a>, <a href="/search?value1=Christopher+Bates&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bates Christopher</a>, <a href="/search?value1=George+Hickman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hickman George</a>, <a href="/search?value1=Tom+Ward&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ward Tom</a>, <a href="/search?value1=Jessica+Morley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Morley Jessica</a>, <a href="/search?value1=Jonathan+Cockburn&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cockburn Jonathan</a>, <a href="/search?value1=Simon+Davy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davy Simon</a>, <a href="/search?value1=Elizabeth+J+Williamson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williamson Elizabeth J</a>, <a href="/search?value1=Rosalind+M+Eggo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eggo Rosalind M</a>, <a href="/search?value1=John+Parry&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Parry John</a>, <a href="/search?value1=Frank+Hester&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hester Frank</a>, <a href="/search?value1=Sam+Harper&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harper Sam</a>, <a href="/search?value1=Shaun+O%E2%80%99Hanlon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">O’Hanlon Shaun</a>, <a href="/search?value1=Alex+Eavis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eavis Alex</a>, <a href="/search?value1=Richard+Jarvis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jarvis Richard</a>, <a href="/search?value1=Dima+Avramov&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Avramov Dima</a>, <a href="/search?value1=Paul+Griffiths&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Griffiths Paul</a>, <a href="/search?value1=Aaron+Fowles&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fowles Aaron</a>, <a href="/search?value1=Nasreen+Parkes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Parkes Nasreen</a>, <a href="/search?value1=Stephen+JW+Evans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Evans Stephen JW</a>, <a href="/search?value1=Ian+J+Douglas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Douglas Ian J</a>, <a href="/search?value1=Liam+Smeeth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Smeeth Liam</a>, <a href="/search?value1=Ben+Goldacre&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Goldacre Ben</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(33):pii=2100885. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.33.2100885" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.33.2100885</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 23 Aug 2021;&nbsp;&nbsp; <span class="generated">Accepted</span>: 28 Apr 2022 </span> </p>
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