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.
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.
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DOI：
10.2807/1560-7917.es.2022.27.33.2100885
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发表时间：
2022-08
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到2021年4月中旬，英格兰的优先患者获得新冠肺炎疫苗接种。临床记录系统中的代码可以表示疫苗被拒绝。我们根据临床和人口统计因素描述了新冠肺炎疫苗被拒绝的记录。在英国国民健康保险制度的批准下，我们在2020年12月8日至2021年5月25日之间进行了一项回顾性队列研究，使用安全的健康分析平台OpenSAFELY对5790万患者进行了初级保健记录。优先接种新冠肺炎的患者是那些年龄为≥ 50岁或≥ 16 岁的临床极易感人群或“高危人群”。我们描述了每组记录的疫苗接种量下降的比例，并按临床和人口子组、随后的疫苗接种和临床代码使用在一般实践中的分布进行分层。在2450万优先患者中，663,033人(2.7%)有下降记录，而2,155,076人(8.8%)既没有疫苗接种也没有下降记录。那些被记录为下降的人，后来接种了疫苗(n = 125,587；18.9%)在南亚人口中所占比例过高(≥ 65岁的其他种族为32.3%比22.8%)。未接种疫苗的患者下降的比例在CEV中最高(3.3%)，种族差异很大(黑人15.3%，南亚5.6%，白人1.5%，≥80年)，并与日益严重的剥夺呈正相关。表明新冠肺炎疫苗接种减少的临床代码在英格兰很常见，但在黑人和南亚人以及更贫困的地区更常见。需要定性研究来确定有记录的下降的典型原因，包括它们在多大程度上反映了患者主动下降的程度。
Priority patients in England were offered COVID-19 vaccination by mid-April 2021. Codes in clinical record systems can denote the vaccine being declined. We describe records of COVID-19 vaccines being declined, according to clinical and demographic factors. 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. 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. 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.