Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: two retrospective cohort analyses of the primary schedule and third dose

Kirsty Morrison, Lucy Cullen, Allan B James, Vera Chua, Christopher Sullivan, Chris Robertson, Jade Carruthers, Rachael Wood, Karen Jeffrey, Calum MacDonald, Syed Ahmar Shah, Igor Rudan, Colin R Simpson, Colin McCowan, Srinivasa Vittal Katikireddi, Zoe Grange, Lewis Ritchie, Aziz Sheikh

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Vaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death.

Aim
To identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one.

Methods
We conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors.

Results
Of 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period.

The most strongly associated predictors for not receiving the second dose were: being aged 18–29 (reference: 50–59 years; aOR:4.26; 95% confidence interval (CI):4.14–4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29–4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16–3.32).

The most strongly associated predictors for not receiving the third dose were: being 18–29 (reference: 50–59 years aOR:4.44; 95%CI: 4.38–4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53–2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30–2.46).

Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule.

Conclusion
We observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.
Original languageEnglish
JournalVaccine
Volume41
Issue number40
Early online date17 Aug 2023
DOIs
Publication statusPublished - 15 Sept 2023

Keywords

  • Vaccine uptake
  • Vaccine hesitancy
  • COVID-19 vaccination
  • Incomplete vaccine schedule

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