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Risk of COVID-19 death in adults who received Autumn 2022 booster vaccinations in England

January 2024: Study published in Nature Communications identify health conditions linked to an increased risk of COVID-19 death, despite receiving their 2022 Autumn boost vaccine.

Risk of COVID-19 death in adults who received booster COVID-19 vaccinations in England

Ward, I; Robertson, C; Agrawal, A; Patterson, L; et.al.

Nature Communications

Published online on: 16 January 2024

Available online at: https://doi.org/10.1038/s41467-023-44276-x

Plain English Summary 


Booster vaccines can improve a person’s immune protection against disease, or help it last longer.

COVID-19 booster vaccines have been offered in the UK since September 2021. These were first offered to people known to be at higher risk of becoming very unwell with COVID-19.

However, from November 2021, all adults were offered a first booster regardless of whether they were at higher risk or not. This was because the Omicron variant of coronavirus SARS-CoV-2 caused a wave of new infections across the UK.

A second booster dose was later offered to those most at risk of severe COVID-19 in Autumn 2022.

Read more about our previous research in this area

Why did we carry out this work? 

The UK has taken a targeted approach when administering booster vaccines. This ensures that booster doses continue to be given to those who need them, whilst also being cost effective.

Previously, our team investigated the risk factors that increased the risk of severe outcomes (hospital admissions and death) after a person received their:

  • Primary vaccinations (first and second doses)
  • First booster

These results were used to help the Joint Committee on Vaccination and Immunisation (JCVI’s) in deciding would be prioritized during the rollout of the second booster vaccine.

Find out more about this work

Unfortunately, despite receiving an Autumn booster dose in 2022, there are people who remain at increased risk of COVID-19 death. However, little is known about them.

Therefore, in this study, we aim to identify the risk of COVID-19 death:

  1. Among people with specific underlying health conditions;
  2. Compared to other causes of death amongst vulnerable groups

How did we do this?

We looked at over 14.6M adults 50-100 in England between 1 September 2022 – 11 April 2023.

To do this we used a dataset made up of de-identified, linked primary care (GP), mortality, vaccination and 2021 Census data.

These individuals previously received two or more doses of a COVID-19 vaccine, and were given their Autumn 2022 booster dose on or after 1 September.

Infographic outlining results from paper looking at the risk of COVID-19 deaths in England following Autumn 2022 booster vaccine
This image was created by the Usher Institute, The University of Edinburgh to accompany work done as part of the Vaccine Booster Breakthroughs project. The study was supported by National Core Studies: Immunity (MC_PC_20061). © 2024 Usher Institute, The University of Edinburgh. All rights reserved.

Clinical risk factors

Compared to those living with no underlying health conditions, and increased risk of COVID-19 death was linked to people living with the following conditions:

Conditions Increased risk of COVID-19 death (times X)
Learning disabilities or Down's Syndrome 5.07
Blood or bone marrow cancer 3.11
Motor neuron disease, multiple sclerosis, myasthenia or Huntington's disease 2.94
Pulmonary hypertension or fibrosis 2.88
Parkinson's disease 2.74
Liver cirrhosis 2.65
Dementia 2.64
Lung or oral cancer 2.57

Risk compared to other causes of death

Compared to other causes of death, an increased risk of COVID death was linked to people living with:

  • Blood or bone marrow cancer
  • Chronic Kidney Disease
  • Cystic Fibrosis
  • Pulmonary hypertension or fibrosis
  • Rheumatoid arthritis or systematic lupus erythematosus

Why is this important? 

Our results highlight which groups of people are proportionately most at risk of dying due to COVID-19.

These findings could be used to help inform policy decision making, by indicating who should be prioritised to receive future booster vaccines.