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Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General P...

Ruby S. M. Tsang, Mark Joy, Rachel Byford, Xuejuan Fan, Gavin Jamie, Debasish Kar, Sneha Anand, William Victor, John Williams, Stuart Bedston, Declan Bradley, Rhiannon Owen Orcid Logo, Fatemeh Torabi Orcid Logo, Emily Lowthian Orcid Logo, Chris Robertson, Jillian Beggs, Gary Howsam, Aziz Sheikh, F.D. Richard Hobbs, Simon de Lusignan

SSRN Electronic Journal

Swansea University Authors: Stuart Bedston, Rhiannon Owen Orcid Logo, Fatemeh Torabi Orcid Logo, Emily Lowthian Orcid Logo

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DOI (Published version): 10.2139/ssrn.4099405

Abstract

Background: Two doses of COVID-19 vaccine offer greater protection than one dose. There are known disparities in COVID-19 outcomes and vaccine uptake. However, it is not known whether non-uptake of the second dose in people who have already received their first dose is predicted by differences in de...

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Published in: SSRN Electronic Journal
ISSN: 1556-5068
Published: Elsevier BV
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URI: https://cronfa.swan.ac.uk/Record/cronfa71655
first_indexed 2026-03-20T07:01:27Z
last_indexed 2026-04-21T07:36:03Z
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There are known disparities in COVID-19 outcomes and vaccine uptake. However, it is not known whether non-uptake of the second dose in people who have already received their first dose is predicted by differences in demographic characteristics and disease risk. Methods: We conducted a retrospective cohort study using computerised medical record data from the nationally representative Oxford-Royal College of General Practitioners primary care sentinel cohort (N=7,952,861). Among adults who received at least one dose of Oxford-AstraZeneca ChAdOx1, mRNA Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccines, we used univariable and multivariable logistic regressions to estimate the odds ratios (ORs) and adjusted ORs (aORs), and their 95% confidence intervals (95% CI), of second dose uptake. Findings: In adults vaccinated with one dose (n=2,802,314), younger age, ethnic minorities, rurality (aOR=0.93 (95% CI 0.91-0.94)), East of England and the South West, current (0.59 (0.58-0.60)) and ex-smokers (0.93 (0.91-0.94)), severe mental illness (0.58 (0.56-0.60)) among other comorbidities, COVID-19 (0.57 (0.55-0.58)) or adverse events after their first dose, were associated with lower second dose uptake. Male sex (1.02 (1.00-1.03)), increasing socioeconomic status, asthma (1.04 (1.02-1.07)), and first dose mRNA vaccine (1.28 (1.27-1.30)) were associated with higher likelihood of second dose uptake. Interpretation: Several demographic and risk groups at higher risk of adverse COVID-19 outcomes are less likely to receive second COVID-19 vaccination. Initiatives to increase vaccine uptake targeting people in sociodemographic groups and with comorbidities where interventions might have the greatest impact are needed.</abstract><type>Journal Article</type><journal>SSRN Electronic Journal</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1556-5068</issnElectronic><keywords/><publishedDay>0</publishedDay><publishedMonth>0</publishedMonth><publishedYear>0</publishedYear><publishedDate>0001-01-01</publishedDate><doi>10.2139/ssrn.4099405</doi><url/><notes>Preprint article before certification by peer review.</notes><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2026-04-20T16:02:36.6078718</lastEdited><Created>2026-03-19T23:26:36.8739655</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Ruby S. M.</firstname><surname>Tsang</surname><order>1</order></author><author><firstname>Mark</firstname><surname>Joy</surname><order>2</order></author><author><firstname>Rachel</firstname><surname>Byford</surname><order>3</order></author><author><firstname>Xuejuan</firstname><surname>Fan</surname><order>4</order></author><author><firstname>Gavin</firstname><surname>Jamie</surname><order>5</order></author><author><firstname>Debasish</firstname><surname>Kar</surname><order>6</order></author><author><firstname>Sneha</firstname><surname>Anand</surname><order>7</order></author><author><firstname>William</firstname><surname>Victor</surname><order>8</order></author><author><firstname>John</firstname><surname>Williams</surname><order>9</order></author><author><firstname>Stuart</firstname><surname>Bedston</surname><orcid/><order>10</order></author><author><firstname>Declan</firstname><surname>Bradley</surname><order>11</order></author><author><firstname>Rhiannon</firstname><surname>Owen</surname><orcid>0000-0001-5977-376X</orcid><order>12</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>13</order></author><author><firstname>Emily</firstname><surname>Lowthian</surname><orcid>0000-0001-9362-0046</orcid><order>14</order></author><author><firstname>Chris</firstname><surname>Robertson</surname><order>15</order></author><author><firstname>Jillian</firstname><surname>Beggs</surname><order>16</order></author><author><firstname>Gary</firstname><surname>Howsam</surname><order>17</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>18</order></author><author><firstname>F.D. 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spelling 2026-04-20T16:02:36.6078718 v2 71655 2026-03-19 Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub) c79d07eaba5c9515c0df82b372b76a41 Stuart Bedston Stuart Bedston true false 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false db5bc529b8a9dfca2b4a268d14e03479 0000-0001-9362-0046 Emily Lowthian Emily Lowthian true false 2026-03-19 MEDS Background: Two doses of COVID-19 vaccine offer greater protection than one dose. There are known disparities in COVID-19 outcomes and vaccine uptake. However, it is not known whether non-uptake of the second dose in people who have already received their first dose is predicted by differences in demographic characteristics and disease risk. Methods: We conducted a retrospective cohort study using computerised medical record data from the nationally representative Oxford-Royal College of General Practitioners primary care sentinel cohort (N=7,952,861). Among adults who received at least one dose of Oxford-AstraZeneca ChAdOx1, mRNA Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccines, we used univariable and multivariable logistic regressions to estimate the odds ratios (ORs) and adjusted ORs (aORs), and their 95% confidence intervals (95% CI), of second dose uptake. Findings: In adults vaccinated with one dose (n=2,802,314), younger age, ethnic minorities, rurality (aOR=0.93 (95% CI 0.91-0.94)), East of England and the South West, current (0.59 (0.58-0.60)) and ex-smokers (0.93 (0.91-0.94)), severe mental illness (0.58 (0.56-0.60)) among other comorbidities, COVID-19 (0.57 (0.55-0.58)) or adverse events after their first dose, were associated with lower second dose uptake. Male sex (1.02 (1.00-1.03)), increasing socioeconomic status, asthma (1.04 (1.02-1.07)), and first dose mRNA vaccine (1.28 (1.27-1.30)) were associated with higher likelihood of second dose uptake. Interpretation: Several demographic and risk groups at higher risk of adverse COVID-19 outcomes are less likely to receive second COVID-19 vaccination. Initiatives to increase vaccine uptake targeting people in sociodemographic groups and with comorbidities where interventions might have the greatest impact are needed. Journal Article SSRN Electronic Journal Elsevier BV 1556-5068 0 0 0 0001-01-01 10.2139/ssrn.4099405 Preprint article before certification by peer review. COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2026-04-20T16:02:36.6078718 2026-03-19T23:26:36.8739655 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Ruby S. M. Tsang 1 Mark Joy 2 Rachel Byford 3 Xuejuan Fan 4 Gavin Jamie 5 Debasish Kar 6 Sneha Anand 7 William Victor 8 John Williams 9 Stuart Bedston 10 Declan Bradley 11 Rhiannon Owen 0000-0001-5977-376X 12 Fatemeh Torabi 0000-0002-5853-4625 13 Emily Lowthian 0000-0001-9362-0046 14 Chris Robertson 15 Jillian Beggs 16 Gary Howsam 17 Aziz Sheikh 18 F.D. Richard Hobbs 19 Simon de Lusignan 20
title Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
spellingShingle Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
Stuart Bedston
Rhiannon Owen
Fatemeh Torabi
Emily Lowthian
title_short Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
title_full Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
title_fullStr Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
title_full_unstemmed Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
title_sort Sociodemographic and Health Factors Affecting Uptake of Second Dose Covid-19 Vaccine in England: Retrospective Cohort Study Using Data from the National Primary Care Sentinel Surveillance Network (Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub)
author_id_str_mv c79d07eaba5c9515c0df82b372b76a41
0d30aa00eef6528f763a1e1589f703ec
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db5bc529b8a9dfca2b4a268d14e03479
author_id_fullname_str_mv c79d07eaba5c9515c0df82b372b76a41_***_Stuart Bedston
0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
db5bc529b8a9dfca2b4a268d14e03479_***_Emily Lowthian
author Stuart Bedston
Rhiannon Owen
Fatemeh Torabi
Emily Lowthian
author2 Ruby S. M. Tsang
Mark Joy
Rachel Byford
Xuejuan Fan
Gavin Jamie
Debasish Kar
Sneha Anand
William Victor
John Williams
Stuart Bedston
Declan Bradley
Rhiannon Owen
Fatemeh Torabi
Emily Lowthian
Chris Robertson
Jillian Beggs
Gary Howsam
Aziz Sheikh
F.D. Richard Hobbs
Simon de Lusignan
format Journal article
container_title SSRN Electronic Journal
institution Swansea University
issn 1556-5068
doi_str_mv 10.2139/ssrn.4099405
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 0
active_str 0
description Background: Two doses of COVID-19 vaccine offer greater protection than one dose. There are known disparities in COVID-19 outcomes and vaccine uptake. However, it is not known whether non-uptake of the second dose in people who have already received their first dose is predicted by differences in demographic characteristics and disease risk. Methods: We conducted a retrospective cohort study using computerised medical record data from the nationally representative Oxford-Royal College of General Practitioners primary care sentinel cohort (N=7,952,861). Among adults who received at least one dose of Oxford-AstraZeneca ChAdOx1, mRNA Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccines, we used univariable and multivariable logistic regressions to estimate the odds ratios (ORs) and adjusted ORs (aORs), and their 95% confidence intervals (95% CI), of second dose uptake. Findings: In adults vaccinated with one dose (n=2,802,314), younger age, ethnic minorities, rurality (aOR=0.93 (95% CI 0.91-0.94)), East of England and the South West, current (0.59 (0.58-0.60)) and ex-smokers (0.93 (0.91-0.94)), severe mental illness (0.58 (0.56-0.60)) among other comorbidities, COVID-19 (0.57 (0.55-0.58)) or adverse events after their first dose, were associated with lower second dose uptake. Male sex (1.02 (1.00-1.03)), increasing socioeconomic status, asthma (1.04 (1.02-1.07)), and first dose mRNA vaccine (1.28 (1.27-1.30)) were associated with higher likelihood of second dose uptake. Interpretation: Several demographic and risk groups at higher risk of adverse COVID-19 outcomes are less likely to receive second COVID-19 vaccination. Initiatives to increase vaccine uptake targeting people in sociodemographic groups and with comorbidities where interventions might have the greatest impact are needed.
published_date 0001-01-01T08:28:19Z
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