Estimating the Effectiveness of First Dose of COVID-19 Vaccine Against Mortality in England: A Quasi-Experimental Study.
Estimating the Effectiveness of First Dose of COVID-19 Vaccine Against Mortality in England: A Quasi-Experimental Study.
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估计英国第一剂 COVID-19 疫苗对死亡率的有效性：一项准实验研究。
DOI：
10.1093/aje/kwac157
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发表时间：
2023
影响因子：
5
通讯作者：
Bermingham C
中科院分区：
文献类型：
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作者：
Bermingham C
估算真实世界的疫苗有效性对于评估2019冠状病毒病（COVID-19）疫苗接种计划和为正在进行的政策应对提供信息至关重要。然而，由于非随机设计和潜在的无法测量的混淆，使用观察数据估计疫苗有效性具有固有的挑战性。我们使用回归不连续设计来估计英格兰疫苗对COVID-19死亡率的有效性，使用的事实是80岁或以上的人优先接种疫苗。这种优先次序导致80-84岁人群的疫苗接种率与疫苗接种运动开始时75-79岁人群的疫苗接种率存在很大差异。我们发现COVID-19死亡率有相应的差异，但非COVID-19死亡率没有相应的差异，这表明我们的方法适当地解决了不可测量的混杂因素问题。我们的研究结果表明，首次接种疫苗可使80岁以上人群的COVID-19死亡风险降低52.6%(95%置信限：15.7,73.4)，这支持了现有证据，即首次接种COVID-19疫苗对老年人COVID-19死亡率具有很强的保护作用。回归不连续模型对疫苗有效性的估计值仅略低于以前发表的使用不同方法的研究，这表明这些估计值不太可能受到未测量的混杂因素的重大影响。
Estimating real-world vaccine effectiveness is vital to assessing the coronavirus disease 2019 (COVID-19) vaccination program and informing the ongoing policy response. However, estimating vaccine effectiveness using observational data is inherently challenging because of the nonrandomized design and potential for unmeasured confounding. We used a regression discontinuity design to estimate vaccine effectiveness against COVID-19 mortality in England using the fact that people aged 80 years or older were prioritized for the vaccine rollout. The prioritization led to a large discrepancy in vaccination rates among people aged 80–84 years compared with those aged 75–79 at the beginning of the vaccination campaign. We found a corresponding difference in COVID-19 mortality but not in non-COVID-19 mortality, suggesting that our approach appropriately addressed the issue of unmeasured confounding factors. Our results suggest that the first vaccine dose reduced the risk of COVID-19 death by 52.6% (95% confidence limits: 15.7, 73.4) in those aged 80 years, supporting existing evidence that a first dose of a COVID-19 vaccine had a strong protective effect against COVID-19 mortality in older adults. The regression discontinuity model’s estimate of vaccine effectiveness is only slightly lower than those of previously published studies using different methods, suggesting that these estimates are unlikely to be substantially affected by unmeasured confounding factors.