Change in age distribution of COVID-19 deaths with the introduction of COVID-19 vaccination

  1. Roberta Pastorino
  2. Angelo Maria Pezzullo
  3. Leonardo Villani
  4. Francesco Andrea Causio
  5. Cathrine Axfors
  6. Despina G. Contopoulos-Ioannidis
  7. Stefania Boccia
  8. John P.A. Ioannidis
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Abstract

Background

Most countries initially deployed COVID-19 vaccines preferentially in elderly populations. Population-level vaccine effectiveness may be heralded by an increase in the proportion of deaths among non-elderly populations that were less covered by vaccination programs.

Methods

We collected data from 40 countries on age-stratified COVID-19 deaths during the vaccination period (1/14/2021-5/31/2021) and two control periods (entire pre-vaccination period and excluding the first wave). We meta-analyzed the proportion of deaths in different age groups in vaccination versus control periods in countries with low vaccination rates; (2) countries with age-independent vaccination policies; and (3) countries with standard age-dependent vaccination policies.

Findings

Countries that prioritized vaccination among older people saw an increasing share of deaths among 0-69 year old people in the vaccination versus the two control periods (summary prevalence ratio 1·32 [95 CI% 1·24-1·41] and 1·35 [95 CI% 1·26-1·44)]. No such change was seen on average in countries with age-independent vaccination policies (1·05 [95 CI% 0·78-1·41 and 0·97 [95 CI% 0·95-1·00], respectively) and limited vaccination (0·93 [95 CI% 0·85-1·01] and 0·95 [95 CI% 0·87-1·03], respectively). Prevalence ratios were associated with the difference of vaccination rates in elderly versus non-elderly people. No significant changes occurred in the share of deaths in age 0-49 among all 0-69 deaths in the vaccination versus pre-vaccination periods.

Interpretation

The substantial shift in the age distribution of COVID-19 deaths in countries that rapidly implemented vaccination predominantly among elderly may herald the population level-effectiveness of COVID-19 vaccination and a favorable evolution of the pandemic towards endemicity with fewer elderly deaths.

Funding

This study received no specific funding.

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