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From admission to vaccination: COVID-19 vaccination patterns and their relationship with hospitalization in trauma
Wardah Rafaqat1, May Abiad2, Emanuele Lagazzi3
1Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Massachusetts General Hospital, Cambridge, MA. Electronic address: https://twitter.com/RafaqatWardah.
Insights
COVID-19 vaccination rates in hospitalized trauma patients initially increased post-admission but did not sustain. Trauma patients had significantly lower vaccination rates than the general population, highlighting a need for integrated healthcare strategies.
Area of Science:
- Public Health
- Epidemiology
- Trauma Care
Background:
- COVID-19 vaccination rates in hospitalized trauma patients are understudied.
- Understanding these rates is crucial for public health interventions.
- Trauma patients may have unique barriers to vaccination.
Purpose of the Study:
- To analyze COVID-19 vaccination trends in hospitalized trauma patients.
- To compare vaccination rates between trauma patients and the general population.
- To identify factors associated with vaccination status in trauma patients.
Main Methods:
- Retrospective study using trauma registry and vaccination data (April 2021-November 2022).
- Inclusion of patients aged 18 years and older.
- Analysis of vaccination changes post-hospitalization, temporal trends, and predictors of non-vaccination using joinpoint and multivariate regression.
Main Results:
- First vaccine dose administration increased in the week post-hospitalization but was not sustained.
- Unvaccinated rates in trauma patients (27.1%) were higher than in the general Massachusetts population (<5%).
- Urban residence, multiple hospitalizations, and frailty were associated with vaccination; younger age groups and certain insurance types were linked to non-vaccination.
Conclusions:
- Hospitalization provides a temporary boost in COVID-19 vaccination for trauma patients.
- Significant disparities in vaccination persist between trauma patients and the general population.
- Sustained healthcare integration strategies are essential to improve vaccination rates in this high-risk group.
Background:
COVID-19 vaccination rates in the hospitalized trauma population are not fully characterized and may lag behind the general population. This study aimed to outline COVID-19 vaccination trends in hospitalized trauma patients and examine how hospitalization influences COVID-19 vaccination rates.
Methods:
We conducted a retrospective institutional study using our trauma registry paired with the COVID-19 vaccination ENCLAVE registry. We included patients ≥18 years admitted between April 21, 2021 and November 30, 2022. Our primary outcome was the change in vaccination posthospitalization, and secondary analyzed outcomes included temporal trends of vaccination in trauma patients and predictors of non-vaccination. We compared pre and posthospitalization weekly vaccination rates. We performed joinpoint regression to depict temporal trends and multivariate regression for predictors of nonvaccination.
Results:
The rate of administration of the first vaccine dose increased in the week after hospitalization (P = .018); however, this increase was not sustained in the following weeks. The percentage of unvaccinated patients declined faster in the general population in Massachusetts compared to the hospitalized trauma population. By the conclusion of the study, 27.1% of the trauma population was unvaccinated, whereas <5% of the Massachusetts population was unvaccinated. Urban residence, having multiple hospitalizations, and experiencing moderate to severe frailty were associated with vaccination. Conversely, being in the age groups 18 to 45 years and 46 to 64 years, as well as having Medicaid or self-pay insurance, were linked to being unvaccinated.
Conclusion:
Hospitalization initially increased the rate of administration of the first vaccine dose in trauma patients, but the effect was not sustained. By the conclusion of the study period, a greater percentage of trauma patients were unvaccinated compared to the general population of Massachusetts. Strategies for sustained health care integration need to be developed to address this ongoing challenge in the high-risk trauma population.
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