The Relationship of COVID-19 Vaccination with Mortality Among 86,732 Hospitalized Patients: Subpopulations, Patient Factors, and Changes over Time

Abstract

Abstract Information on COVID-19 vaccination effects on mortality among patients hospitalized with COVID-19 could inform vaccination outreach efforts and increase understanding of patient risk. Determine the associations of vaccination status with mortality in adult patients hospitalized with COVID-19. This retrospective cohort study assessed the characteristics and mortality rates of adult patients hospitalized with COVID-19 across 21 healthcare systems in the USA from January 1, 2021, to January 31, 2022. Adult patients admitted to participating hospitals who had COVID-19 diagnoses and/or positive PCR tests and completed their hospital stay via discharge or death. In-hospital mortality vs. discharge (outcome) and patient age, sex, race, ethnicity, BMI, insurance status, comorbidities, and vaccination status extracted from the electronic health record (EHR). Of 86,732 adult patients hospitalized with COVID-19, 45,082 (52%) were female, mean age was 60 years, 20,800 (24%) were Black, and 22,792 (26.3%) had one or more COVID-19 vaccinations. Statistically adjusted mortality rates for unvaccinated and vaccinated patients were 8.3% (95% CI, 8.1–8.5) and 5.1% (95% CI, 4.8–5.4) respectively (7.9% vs. 4.5% with no immune compromise). Vaccination was associated with especially large reductions in mortality for obese (OR = 0.67; 95% CI 0.56–0.80) and severely obese (OR = 0.52; 95% CI, 0.41–0.67) patients and for older patients (OR = 0.99; 95% CI, 0.98–0.99). Mortality likelihood was higher later in the study period (August 2021–January 31, 2022) than earlier (January 1, 2021–July 30, 2021) (OR = 1.10; 95% CI = 1.04–1.17) and increased significantly for vaccinated patients from 4.6% (95% CI, 3.9–5.2%) to 6.5% (95% CI, 6.2–6.9%). Patients vaccinated for COVID-19 had reduced mortality, especially for obese/severely obese and older individuals. Vaccination’s protective effect against mortality declined over time and hospitalized obese and older individuals may derive especially great benefit from prior vaccination against SARS-CoV-2.