• Timothy B Baker, Daniel M Bolt, Stevens S Smith, Thomas M Piasecki, Karen L Conner, Steven L Bernstein, Todd Hayes-Birchler, Wendy E Theobald, and Michael C Fiore.
• Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St #200, Madison, WI, 53711, USA. tbb@ctri.medicine.wisc.edu.
• J Gen Intern Med. 2023 Apr 1; 38 (5): 124812551248-1255.

BackgroundInformation on COVID-19 vaccination effects on mortality among patients hospitalized with COVID-19 could inform vaccination outreach efforts and increase understanding of patient risk.ObjectiveDetermine the associations of vaccination status with mortality in adult patients hospitalized with COVID-19.DesignThis retrospective cohort study assessed the characteristics and mortality rates of adult patients hospitalized with COVID-19 across 21 healthcare systems in the USA from January 1, 2021, to January 31, 2022.ParticipantsAdult patients admitted to participating hospitals who had COVID-19 diagnoses and/or positive PCR tests and completed their hospital stay via discharge or death.Main MeasureIn-hospital mortality vs. discharge (outcome) and patient age, sex, race, ethnicity, BMI, insurance status, comorbidities, and vaccination status extracted from the electronic health record (EHR).Key ResultsOf 86,732 adult patients hospitalized with COVID-19, 45,082 (52%) were female, mean age was 60 years, 20,800 (24%) were Black, and 22,792 (26.3%) had one or more COVID-19 vaccinations. Statistically adjusted mortality rates for unvaccinated and vaccinated patients were 8.3% (95% CI, 8.1-8.5) and 5.1% (95% CI, 4.8-5.4) respectively (7.9% vs. 4.5% with no immune compromise). Vaccination was associated with especially large reductions in mortality for obese (OR = 0.67; 95% CI 0.56-0.80) and severely obese (OR = 0.52; 95% CI, 0.41-0.67) patients and for older patients (OR = 0.99; 95% CI, 0.98-0.99). Mortality likelihood was higher later in the study period (August 2021-January 31, 2022) than earlier (January 1, 2021-July 30, 2021) (OR = 1.10; 95% CI = 1.04-1.17) and increased significantly for vaccinated patients from 4.6% (95% CI, 3.9-5.2%) to 6.5% (95% CI, 6.2-6.9%).ConclusionsPatients vaccinated for COVID-19 had reduced mortality, especially for obese/severely obese and older individuals. Vaccination's protective effect against mortality declined over time and hospitalized obese and older individuals may derive especially great benefit from prior vaccination against SARS-CoV-2.© 2023. The Author(s).

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