Model to Estimate Risk of SARS-CoV-2-Related Death to Prioritize Vaccination

Ioannou, et al. (2021) sought to develop a model that estimates the risk of SARS-CoV-2–related mortality among all enrollees of the US Department of Veterans Affairs (VA) healthcare system.

This prognostic study used data from 7,635,064 individuals enrolled in the VA healthcare system as of May 21, 2020, to develop and internally validate a logistic regression model (COVIDVax) that predicted SARS-CoV-2–related death (n = 2422) during the observation period (May 21 to Nov. 2, 2020) using baseline characteristics known to be associated with SARS-CoV-2–related mortality, extracted from the VA electronic health records (EHRs). The cohort was split into a training period (May 21 to September 30) and testing period (October 1 to November 2).

Of 7 635 064 individuals, the mean (SD) age was 66.2 (13.8) years, and most were men (7 051 912 [92.4%]) and White individuals (4 887 338 [64.0%]), with 1 116 435 (14.6%) Black individuals and 399 634 (5.2%) Hispanic individuals. From a starting pool of 16 potential predictors, 10 were included in the final COVIDVax model, as follows: sex, age, race, ethnicity, body mass index, Charlson Comorbidity Index, diabetes, chronic kidney disease, congestive heart failure, and Care Assessment Need score. The model exhibited excellent discrimination with area under the receiver operating characteristic curve (AUROC) of 85.3% (95% CI, 84.6%-86.1%), superior to the AUROC of using age alone to stratify risk (72.6%; 95% CI, 71.6%-73.6%). Assuming vaccination is 90% effective at preventing SARS-CoV-2–related death, using this model to prioritize vaccination was estimated to prevent 63.5% of deaths that would occur by the time 50% of VA enrollees are vaccinated, significantly higher than the estimate for prioritizing vaccination based on age (45.6%) or the Centers for Disease Control and Prevention phases of vaccine allocation (41.1%).

In this prognostic study of all VA enrollees, prioritizing vaccination based on the COVIDVax model was estimated to prevent a large proportion of deaths expected to occur during vaccine rollout before sufficient herd immunity is achieved.

Reference: Ioannou GN, et al. Development of COVIDVax Model to Estimate the Risk of SARS-CoV-2–Related Death Among 7.6 Million US Veterans for Use in Vaccination Prioritization. JAMA Netw Open. 2021;4(4):e214347. doi:10.1001/jamanetworkopen.2021.4347

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