Risk of death following SARS-CoV-2 infection or COVID-19 vaccination in young people in England: a self-controlled case series study
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Objectives
To assess whether there is a change in the incidence of cardiac and all-cause death in young people following COVID-19 vaccination or SARS-CoV-2 infection in unvaccinated individuals.
Design
Self-controlled case series.
Setting
National, linked electronic health record data in England.
Study population
Individuals aged 12-29 who had received at least one dose of COVID-19 vaccination and died between 8 December 2020 and 2 February 2022 and registered by 16 February 2022 within 12 weeks of COVID-19 vaccination; Individuals aged 12-29 who died within 12 weeks of testing positive for SARS-CoV-2.
Main outcome measures
Cardiac and all-cause deaths occurring within 12 weeks of vaccination or SARS-CoV-2 infection.
Results
Compared to the baseline period, there was no evidence of a change in the incidence of cardiac death in the six weeks after vaccination, whether for each of weeks 1 to 6 or the whole six-week period. There was a decrease in the risk of all-cause death in the first week after vaccination and no change in each of weeks 2 to 6 after vaccination or whole six-week period after vaccination. Subgroup analyses by sex, age, vaccine type, and last dose also showed no change in the risk of death in the first six weeks after vaccination. There was a large increase in the incidence of cardiac and all-cause death in the overall risk period after SARS-CoV-2 infection among the unvaccinated.
Conclusion
There is no evidence of an association between COVID-19 vaccination and an increased risk of death in young people. By contrast, SARS-CoV-2 infection was associated with substantially higher risk of cardiac related death and all-cause death.
What is already known on this topic
Several studies have highlighted the association between COVID-19 vaccination and the risk of myocarditis, myopericarditis, and other cardiac problems, especially in young people, but associated risk of mortality is unclear. Since younger people have lower risk of COVID-19 hospitalisation and mortality, the mortality risk associated with vaccination is potentially more important to them in balancing the risk and benefit of vaccination.
What this study adds
Although there is a risk of myocarditis or myopericarditis with COVID-19, there is no evidence of increased risk of cardiac or all-cause mortality following COVID-19 vaccination in young people aged 12 to 29. Given the increased risk of mortality following SARS-CoV-2 infection in this group, the risk-benefit analysis favours COVID-19 vaccination for this age group.
Article activity feed
-
SciScore for 10.1101/2022.03.22.22272775: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study has several strengths. First, we used death registration records for the whole of England, linked to all vaccination records, including those which are not available in the main NIMS COVID-19 vaccination data, because …
SciScore for 10.1101/2022.03.22.22272775: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: Our study has several strengths. First, we used death registration records for the whole of England, linked to all vaccination records, including those which are not available in the main NIMS COVID-19 vaccination data, because the people died shortly after vaccination. As a result, we had information on the cause of death based on medical certificate of cause of death. To limit further the risk of outcome misclassification, we not only examined deaths due to cardiac events but also all-cause mortality. Second, using a self-controlled case series, our estimates account for time-invariant confounding, which is crucial because young people who were clinically extremely vulnerable were prioritised for vaccination. Comparing the risk of deaths between vaccinated and unvaccinated individuals would have been challenging in the absence of detailed information on pre-existing health status. The main limitation of our study is the delay in death registration. Not all deaths that occurred in the period have already been registered and registration delays can be substantial for young people, as deaths are more likely to be investigated by a coroner than for older adults. Registration delays should affect more deaths that occurred later in the year, and therefore deaths that occurred further from vaccination status, leading to overestimating the incidence case ratios. To minimise the impact of registration delays, we restricted the follow up period to 12 weeks ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
-
