The status and influencing factors of COVID-19 vaccination in patients with COPD – Nature.com

Basic characteristics of the survey respondents and factors affecting the COVID-19 vaccination rate

The KMO value was 0.942 and the Bartletts sphericity test value was significant (P<0.001), indicating high validity. The Cronbachs alpha was 0.889, indicating high reliability. The total number of individuals that participated was 1936; however, 38 individuals were excluded because they did not meet the diagnostic criteria for COPD. Altogether, 1898 questionnaires were completed, of which 24 were regarded as invalid, and finally 1,874 valid questionnaires were obtained (validity rate of 98.74%). The age of the patients was mostly 5565-years (n=564, 30.10%); the height was mostly 160170cm (n=721, 38.47%); the weight was mostly 5060kg (n=596, 31.80%); the patients were mostly male, accounting for 56.78% (n=1064); patients in junior high school accounted for the largest proportion (n=649, 34.63%); and married patients accounted for the majority of patients (n=1290, 68.84%). Most patients needed care (n=1476, 78.76%), while unattended patients accounted for only 21.24% (n=398). Cumulatively, 77.16% (n=1446) of the patients were covered by rural cooperative or urban medical insurance, 19.69% (n=369) were self-financed for medical care, and 3.15% (n=59) were covered by public medical care. Most of the families had per capita monthly incomes of 3,0005,000 yuan (n=900, 48.03%), and 36.87% (n=691) of the patients had a history of allergy. A history of smoking was present in 52.56% of the patients (n=985), with the majority having a smoking history of 1020years (n=252, 25.58%), and smoked 510 cigarettes per day (n=322, 32.69%). Univariate analysis revealed that age (P<0.001), marital status (P<0.001), monthly income (P<0.001), habitual residence (P<0.001), household income (P=0.007), history of allergy (P<0.001), smoking status (P<0.001), years of smoking (P<0.001), and number of cigarettes smoked per day (P<0.001) were the key factors affecting COVID-19 vaccination rate. Details are presented in Table 1.

In the survey, more than half of the patients were diagnosed with COPD for the first time (n=1114, 59.45%), and for patients who had been diagnosed with COPD before, the duration of illness was mostly <5years (n=321, 42.24%); nearly half of the patients indicated that they did not have much knowledge regarding COPD (n=963, 51.39%), and 40.00% (n=937) had 12 acute exacerbations of the disease in the past year, while half of the patients were not hospitalized for acute exacerbation (n=852, 45.46%); nearly one-third of the patients did not use medication for COPD regularly (n=554, 29.56%). We recommended treatments based on established guidelines for patients who did not receive regular treatment. 33.62% of the patients (n=630) and 15.64% of the patients (n=293) underwent home oxygen therapy and used non-invasive ventilation machines, respectively; more than half of the patients considered their current health status fair (n=1051, 56.08%). After comparisons, we established whether COPD was diagnosed for the first time (P=0.002), duration of COPD (P<0.001), number of acute exacerbations of COPD in the last year (P<0.001), number of hospitalizations for acute exacerbations in the last year (P<0.001), comorbidities with other systemic diseases (P<0.001), the severity of the current disease, including the degree of dyspnea (P<0.001), degree of cough (P=0.048), degree of expectoration (P<0.001), degree of wheezing (P<0.001), home activities influenced by COPD (P<0.001), ability to go outside (P<0.001), sleep quality (P=0.005), energy level (P<0.001), and current physical condition (P<0.001), regularity of medication (P<0.001), home oxygen therapy (P<0.001), and application of non-invasive ventilation machines (P<0.001) were factors that significantly different in the COVID-19 vaccination rate. The details are presented in Table 2.

Most patients had not been injected with the relevant vaccines (n=936, 49.95%), and among those who had been injected with the relevant vaccines, the influenza vaccine had been administered to the highest number of patients (n=688, 36.71%). The results of the univariate analysis revealed statistically significant differences in the COVID-19 vaccination rate based on whether other vaccines had been injected and whether an adverse reaction had occurred after the injection of other vaccines (both P<0.001). The details are presented in Table 3. Approximately a third of the patients experienced adverse reactions after vaccination (n=281; 29.18%). The most frequent adverse reaction was malaise (n=203, 72.24%) followed by digestive tract symptoms (n=197, 70.11%). The adverse reactions of influenza, pneumonia, or herpes zoster vaccines in patients with COPD are shown in Fig.1.

Adverse reactions of influenza, pneumonia, or herpes zoster vaccines in patients with COPD. COPD, chronic obstructive pulmonary disease.

The vast majority of the patients were currently inoculated with the COVID-19 vaccine (n=1473, 78.60%); among them, 50.31% (n=741) had received three doses of the COVID-19 vaccine, 42.50% (n=626) had received two doses of the COVID-19 vaccine, and only 7.20% (n=106) had received one dose of COVID-19 vaccine (Fig.2A,B). The reason for vaccination was self-selected as the need for disease prevention (n=1050, 70.47%). Fear of causing exacerbation or recurrence of the disease of COPD (n=113, 45.75%) was foremost among the reasons for not having received the COVID-19 vaccine yet. Only 33.14% (n=629) of the patients were worried about the exacerbation of COPD after vaccination prior to receiving the vaccine, and the most common concern was adverse reactions after vaccination (n=900, 47.42%). Most patients had no concerns regarding the COVID-19 vaccine (n=921, 48.52%). The reasons for this are summarized in Table 4.

Status of COVID-19 vaccine in patients with COPD and the number of doses. (A) Status of COVID-19 vaccination in patients with COPD; (B) Number of doses of the COVID-19 vaccine in patients with COPD. COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019.

Nearly half of the patients consulted medical staff regarding COVID-19 vaccination (n=913, 48.72%). Most patients who consulted medical staff received answers (n=634, 69.44%), while only a few patients found the consultation method inconvenient or very inconvenient (n=171, 18.73%). Medical staff recommended the COVID-19 vaccine to most patients (n=1270, 67.77%). The vast majority of patients with COPD had not yet contracted COVID-19 pneumonia (n=1730, 92.32%). More than half of the patients were concerned about contracting COVID-19 (n=1039, 55.44%), and 87.09% (n=1584) believed that the vaccine could prevent COVID-19 infection, and 86.88% believed that the current COVID-19 vaccine was very safe (n=538, 28.71%) or safe (n=1094, 58.38%). The results demonstrated statistically significant differences in COVID-19 vaccination rates among those who had been infected with COVID-19 (P<0.001), those who were concerned about contracting COVID-19 (P=0.001), those who believed that vaccines could prevent COVID-19 (P<0.001), their views on current vaccine safety (P<0.001), whether they received answers after consulting medical staff about COVID-19 vaccination (P=0.001), and whether medical staff recommended COVID-19 vaccination (P<0.001). The attitudes of the respondents toward the COVID-19 vaccine and the factors affecting the COVID-19 vaccination rate are presented in Table 5.

The COVID-19 vaccines administered to patients with COPD include CoronaVac, Sinopharm/BIBP (Beijing Institute of Biological Products Co., Ltd.), Sinopharm/WIBP (Wuhan Institute of Biological Products Co., Ltd), CanSinoBio, Zhifei Longcom, KCONECAVAC, and IMBCAMS. In total, 1473 patients with COPD received one dose, 1367 patients with COPD received two doses, and 741 patients with COPD received three doses. The most commonly administered vaccines for the first dose in patients with COPD were CoronaVac (n=551, 37.41%) and Sinopharm/BIBP (n=507, 34.42%). The most commonly administered vaccines for the second dose in patients with COPD were CoronaVac (n=507, 37.09%) and Sinopharm/BIBP (n=441, 32.26%). The most commonly administered vaccines for the third dose in patients with COPD were CoronaVac (n=276, 37.25%) and Sinopharm/BIBP (n=242, 32.66%) (Fig.3).

Brands and number of COVID-19 vaccinations in patients with COPD. COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019.

Only a small number of patients experienced adverse reactions after receiving the COVID-19 vaccine: 18.94% (n=279), 16.39% (n=224), and 12.55% (n=93) after the first, second, and third doses, respectively. Most adverse reactions occurred within 48h of injection for the first (n=171, 61.29%) and second doses (n=129, 57.59%), whereas adverse reactions occurred primarily within 24h after the third vaccination (n=27, 29.03%) (Fig.4). Adverse reactions were similar for all three doses of the COVID-19 vaccine, with very few systemic adverse reactions. The most adverse reactions were weakness or muscle soreness in 74.91% (n=209) and 71.33% (n=199) for the first injection and 59.82% (n=134) and 67.41% (n=151) for the second injection. The adverse reactions after the third injection more often manifested as muscle soreness or redness, swelling, and pain at the injection site in 54.84% (n=51) and 53.76% (n=50) patients (Fig.5).

Occurrence of adverse reactions to COVID-19 vaccine in patients with COPD. COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019.

Adverse reactions to COVID-19 vaccine in patients with COPD. COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019.

Using COVID-19 vaccination as the dependent variable, all statistically significant indicators in the univariate analysis were included as independent variables. To eliminate possible associations between the variables, a multicollinearity diagnosis was performed before including them in the multivariate analysis. Our results indicated that tolerance was greater than 0.1, and the variance inflation factor was less than 5. There was no significant collinearity among the factors. Stepwise regression was adopted in the multivariate analysis and the collinearity of the variables was further restricted. The results of multivariate logistic regression analyses (Table 6) revealed that the factors that influenced COVID-19 vaccination were: age being 7585years (OR=1.822, 95% CI 1.0233.246) (P=0.042) and >85years (OR=2.609, 95% CI 1.0016.802) (P=0.050), 34 times of acute exacerbations in the last year (OR=1.693, 95% CI 1.2222.555) (P=0.012), comorbid cardiovascular system diseases (such as hypertension, coronary artery disease, and heart failure) (OR=1.544, 95% CI 1.1852.010) (P=0.001), and comorbid endocrine system diseases (such as diabetes and osteoporosis) (OR=1.762, 95% CI 1.3272.339) (P<0.001), not taking regular medication for COPD (OR=1.357, 95% CI 1.0321.784) (P=0.029), application of non-invasive ventilation machines (OR=1.469, 95% CI 1.0632.029) (P=0.020), perceiving current health condition as deteriorating (OR=1.863, 95% CI 1.2032.886) (P=0.005), perceived current COVID-19 vaccine as unsafe (OR=2.813, 95% CI 1.8544.269) (P<0.001) and very unsafe (OR=2.215, 95% CI 1.0224.802) (P=0.044), medical staff did not provide a clear answer as to whether they recommended COVID-19 vaccination (OR=1.664, 95% CI 1.2422.229) (P=0.001), medical staff did not recommend the COVID-19 vaccine (OR=3.695, 95% CI 2.4495.575) (P<0.001), fear of adverse reactions after vaccination (OR=1.575, 95% CI 1.11962.074) (P=0.001), and exacerbation of COPD (OR=1.811, 95% CI 1.37762.382) (P<0.001).

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