Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study

Jennifer K. Quint; Sabada Dube; Lucy Carty; Renata Yokota; Samira Bell; Lance Turtle; Yi Lu; Kathryn Evans; Nahila Justo; Michelle  Harley; Jurgens  Peters; Carla  Talarico; Richard McNulty; Ana Goios; Sylvia Taylor; Rachael A. Evans

doi:10.1016/j.jinf.2025.106432

Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study

Jennifer K. Quint, Sabada Dube, Lucy Carty, Renata Yokota, Samira Bell, Lance Turtle, Yi Lu, Kathryn Evans, Nahila Justo, Michelle Harley, Jurgens Peters, Carla Talarico, Richard McNulty, Ana Goios, Sylvia Taylor, Rachael A. Evans

Population Health and Genomics

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives
We aimed to characterise COVID-19 severity, mortality and healthcare utilisation in immunocompromised individuals in England during 2023, using INFORM study data.

Methods
Retrospective cohort study (ISRCTN53375662) using pseudonymised electronic health records of individuals aged ≥12 years from a random 25% sample of England’s population. Over 1 January–31 December 2023, adjusted incidence rate ratios (aIRRs; adjusted for age, sex, non-immunocompromising comorbidities) between immunocompromised and non-immunocompromised individuals for COVID-19-related hospitalisation, death, and healthcare utilisation were estimated.

Results
Immunocompromised individuals represented 4.0% of 12,056,685 individuals studied but accounted for 21.7% and 21.9% of COVID-19 hospitalisations and deaths, respectively. Risk of severe COVID-19 was elevated for immunocompromised vs. non-immunocompromised; aIRRs: 2.04, 95% CI 1.95–2.14 (COVID-19 hospitalisation); 1.69, 95% CI 1.53–1.87 (COVID-19 death). COVID-19 vaccination was more likely in immunocompromised vs. non-immunocompromised (≥4 doses 72.6% vs. 29.8%). The aIRRs for COVID-19-related general practitioner consultations and accident and emergency/day case visits were 2.26 (95% CI 2.22−2.29) and 3.02 (95% CI 2.84−3.20), respectively, for immunocompromised vs. non-immunocompromised.

Conclusions
Beyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination. These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations.

Original language	English
Article number	106432
Journal	Journal of Infection
Early online date	31 Jan 2025
DOIs	https://doi.org/10.1016/j.jinf.2025.106432
Publication status	E-pub ahead of print - 31 Jan 2025

Keywords

COVID-19
immunocompromised
outcomes
retrospective cohort study
health care resource utilisation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jinf.2025.106432Licence: CC BY-NC-ND

Cite this

Quint, J. K., Dube, S., Carty, L., Yokota, R., Bell, S., Turtle, L., Lu, Y., Evans, K., Justo, N., Harley, M., Peters, J., Talarico, C., McNulty, R., Goios, A., Taylor, S., & Evans, R. A. (2025). Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study. Journal of Infection, Article 106432. Advance online publication. https://doi.org/10.1016/j.jinf.2025.106432

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title = "Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study",

abstract = "ObjectivesWe aimed to characterise COVID-19 severity, mortality and healthcare utilisation in immunocompromised individuals in England during 2023, using INFORM study data.MethodsRetrospective cohort study (ISRCTN53375662) using pseudonymised electronic health records of individuals aged ≥12 years from a random 25% sample of England{\textquoteright}s population. Over 1 January–31 December 2023, adjusted incidence rate ratios (aIRRs; adjusted for age, sex, non-immunocompromising comorbidities) between immunocompromised and non-immunocompromised individuals for COVID-19-related hospitalisation, death, and healthcare utilisation were estimated.ResultsImmunocompromised individuals represented 4.0% of 12,056,685 individuals studied but accounted for 21.7% and 21.9% of COVID-19 hospitalisations and deaths, respectively. Risk of severe COVID-19 was elevated for immunocompromised vs. non-immunocompromised; aIRRs: 2.04, 95% CI 1.95–2.14 (COVID-19 hospitalisation); 1.69, 95% CI 1.53–1.87 (COVID-19 death). COVID-19 vaccination was more likely in immunocompromised vs. non-immunocompromised (≥4 doses 72.6% vs. 29.8%). The aIRRs for COVID-19-related general practitioner consultations and accident and emergency/day case visits were 2.26 (95% CI 2.22−2.29) and 3.02 (95% CI 2.84−3.20), respectively, for immunocompromised vs. non-immunocompromised.ConclusionsBeyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination. These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations.",

keywords = "COVID-19, immunocompromised, outcomes, retrospective cohort study, health care resource utilisation",

author = "Quint, {Jennifer K.} and Sabada Dube and Lucy Carty and Renata Yokota and Samira Bell and Lance Turtle and Yi Lu and Kathryn Evans and Nahila Justo and Michelle Harley and Jurgens Peters and Carla Talarico and Richard McNulty and Ana Goios and Sylvia Taylor and Evans, {Rachael A.}",

year = "2025",

month = jan,

day = "31",

doi = "10.1016/j.jinf.2025.106432",

language = "English",

journal = "Journal of Infection",

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TY - JOUR

T1 - Immunocompromised individuals remain at risk of COVID-19

T2 - 2023 results from the observational INFORM study

AU - Quint, Jennifer K.

AU - Dube, Sabada

AU - Carty, Lucy

AU - Yokota, Renata

AU - Bell, Samira

AU - Turtle, Lance

AU - Lu, Yi

AU - Evans, Kathryn

AU - Justo, Nahila

AU - Harley, Michelle

AU - Peters, Jurgens

AU - Talarico, Carla

AU - McNulty, Richard

AU - Goios, Ana

AU - Taylor, Sylvia

AU - Evans, Rachael A.

PY - 2025/1/31

Y1 - 2025/1/31

N2 - ObjectivesWe aimed to characterise COVID-19 severity, mortality and healthcare utilisation in immunocompromised individuals in England during 2023, using INFORM study data.MethodsRetrospective cohort study (ISRCTN53375662) using pseudonymised electronic health records of individuals aged ≥12 years from a random 25% sample of England’s population. Over 1 January–31 December 2023, adjusted incidence rate ratios (aIRRs; adjusted for age, sex, non-immunocompromising comorbidities) between immunocompromised and non-immunocompromised individuals for COVID-19-related hospitalisation, death, and healthcare utilisation were estimated.ResultsImmunocompromised individuals represented 4.0% of 12,056,685 individuals studied but accounted for 21.7% and 21.9% of COVID-19 hospitalisations and deaths, respectively. Risk of severe COVID-19 was elevated for immunocompromised vs. non-immunocompromised; aIRRs: 2.04, 95% CI 1.95–2.14 (COVID-19 hospitalisation); 1.69, 95% CI 1.53–1.87 (COVID-19 death). COVID-19 vaccination was more likely in immunocompromised vs. non-immunocompromised (≥4 doses 72.6% vs. 29.8%). The aIRRs for COVID-19-related general practitioner consultations and accident and emergency/day case visits were 2.26 (95% CI 2.22−2.29) and 3.02 (95% CI 2.84−3.20), respectively, for immunocompromised vs. non-immunocompromised.ConclusionsBeyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination. These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations.

AB - ObjectivesWe aimed to characterise COVID-19 severity, mortality and healthcare utilisation in immunocompromised individuals in England during 2023, using INFORM study data.MethodsRetrospective cohort study (ISRCTN53375662) using pseudonymised electronic health records of individuals aged ≥12 years from a random 25% sample of England’s population. Over 1 January–31 December 2023, adjusted incidence rate ratios (aIRRs; adjusted for age, sex, non-immunocompromising comorbidities) between immunocompromised and non-immunocompromised individuals for COVID-19-related hospitalisation, death, and healthcare utilisation were estimated.ResultsImmunocompromised individuals represented 4.0% of 12,056,685 individuals studied but accounted for 21.7% and 21.9% of COVID-19 hospitalisations and deaths, respectively. Risk of severe COVID-19 was elevated for immunocompromised vs. non-immunocompromised; aIRRs: 2.04, 95% CI 1.95–2.14 (COVID-19 hospitalisation); 1.69, 95% CI 1.53–1.87 (COVID-19 death). COVID-19 vaccination was more likely in immunocompromised vs. non-immunocompromised (≥4 doses 72.6% vs. 29.8%). The aIRRs for COVID-19-related general practitioner consultations and accident and emergency/day case visits were 2.26 (95% CI 2.22−2.29) and 3.02 (95% CI 2.84−3.20), respectively, for immunocompromised vs. non-immunocompromised.ConclusionsBeyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination. These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations.

KW - COVID-19

KW - immunocompromised

KW - outcomes

KW - retrospective cohort study

KW - health care resource utilisation

U2 - 10.1016/j.jinf.2025.106432

DO - 10.1016/j.jinf.2025.106432

M3 - Article

C2 - 39894447

SN - 0163-4453

JO - Journal of Infection

JF - Journal of Infection

M1 - 106432

ER -

Immunocompromised individuals remain at risk of COVID-19: 2023 results from the observational INFORM study

Abstract

Keywords

UN SDGs

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