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

Background: Kidney disease is a significant risk factor for COVID-19-related mortality. Achieving high COVID-19 vaccine coverage among people with kidney disease is therefore a public health priority. Methods: With the approval of NHS England, we performed a retrospective cohort study using the OpenSAFELY-TPP platform. Individual-level routine clinical data from 24 million people in England were included. A cohort of individuals with stage 3-5 chronic kidney disease (CKD) or receiving renal replacement therapy (RRT) at the start of the COVID-19 vaccine roll-out was identified based on evidence of reduced estimated glomerular filtration rate or inclusion in the UK Renal Registry. Individual-level factors associated with vaccine uptake were explored via Cox proportional hazards models. Results: 948,845 people with stage 3-5 CKD or receiving RRT were included. Cumulative vaccine coverage as of 11th May 2022 was 97.5%, 97.0%, and 93.5% for doses 1, 2, and 3, respectively, and 61.1% among individuals with one or more indications for receipt of a fourth dose. Delayed 3-dose vaccine uptake was associated with non-White ethnicity, social deprivation, and severe mental illness - associations that were consistent across CKD stages and in RRT recipients. Similar associations were observed for 4-dose uptake, which was also delayed among care home residents. Conclusion: Although high primary and booster dose coverage has been achieved among people with kidney disease in England, key disparities in vaccine uptake remain across demographic groups. Identifying how to address these disparities remains a priority to reduce the risk of severe disease in this vulnerable patient group.

Outcomes 149 We report on cumulative coverage for doses 1, 2, 3, 4, and 5 (via any combination of vaccine 150 products) up to 11 th May 2022. For the analysis of individual-level factors associated with 151 vaccine uptake, our primary outcome was receipt of a 3-dose series of any vaccine product.

152
For the purposes of this study, we do not distinguish between third primary and booster 153 doses, or between 100 µg (full) or 50 µg (half) doses of the vaccine product mRNA-1273 154 (with the latter recommended for booster doses).     Patients were not directly involved in developing this study. We maintain a publicly 220 available website (https://opensafely.org) through which members of the public or patient 221 groups are invited to contact us regarding this study or the broader OpenSAFELY project.  Figure 1). Of these, 66.1% had CKD3a, 24.9% had CKD3b, 6.7% had CKD4-5, 1.0% were 229 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint receiving RRT via dialysis, and 1.3% were receiving RRT via kidney transplant. Clinical and 230 demographic characteristics of the overall cohort and kidney disease subgroups are 231 summarised in Table 1. In comparison to people with CKD, RRT recipients were markedly 232 younger (with associated declines in several age-associated comorbidities) and were more 233 likely to be male and non-White.  Table 2). To mitigate 257 potential overadjustment bias, we report on partially adjusted models hereafter.        CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint        CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 16, 2022.  . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint  CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint  CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint  . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 16, 2022. ; https://doi.org/10.1101/2022.06.14.22276391 doi: medRxiv preprint