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Severe COVID-19, vaccination, and mortality among individuals with asthma: A Nationwide population-based cohort study
Sang Hyuk Kim1, Min Gu Kang2, Jong Geol Jang3
1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea; Department of Medicine, Korea University Graduate School of Medicine, Seoul, Republic of Korea.
Background:
Severe coronavirus disease 2019 (COVID-19) often results in worse outcomes, including mortality, in individuals with asthma compared to those without the lung disease. However, it remains uncertain whether COVID-19 vaccination improves long-term mortality in individuals with asthma.
Methods:
Using the Korean National Health Insurance System database, individuals with asthma were classified into four groups based on COVID-19 vaccination and COVID-19 infection status: vaccinated/uninfected, vaccinated/infected, unvaccinated/uninfected, and unvaccinated/infected individuals. After 1:1:1:1 propensity score matching, 3384 individuals with asthma were included. The primary outcome was all-cause mortality. Two multivariable models were employed: Model 1 used the unvaccinated/infected group as the reference, while Model 2 used the unvaccinated/uninfected group as the reference.
Results:
Over a median follow-up duration of 350 days (interquartile ranges, 294-407 days), the mortality rate was highest in the unvaccinated/infected individuals (3481 per 10,000 person-years) and lowest in the vaccinated/uninfected individuals (94 per 10,000 person-years). In Model 1, among individuals with severe COVID-19, prior COVID-19 vaccination was associated with a 61 % reduction in mortality (hazard ratio [HR]: 0.39, 95 % confidence interval [CI]: 0.31-0.50). The risk of mortality was further decreased among uninfected individuals (HR: 0.15, 95 % CI: 0.10-0.21 for unvaccinated/uninfected individuals; HR: 0.04, 95 % CI: 0.02-0.07 for vaccinated/uninfected individuals). In Model 2, among uninfected individuals, COVID-19 vaccination exhibited a 74 % reduction in mortality risk (HR: 0.26; 95 % CI: 0.13-0.52), whereas individuals experiencing severe COVID-19 had markedly elevated mortality risks (HR: 2.69, 95 % CI: 1.84-3.92 for vaccinated/infected individuals and HR: 6.85, 95 % CI: 4.86-9.67 for unvaccinated/infected individuals).
Conclusions:
The COVID-19 vaccination was associated with reduced long-term mortality in individuals with asthma, regardless of COVID-19 status.
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