Objectives To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination. Design Prospective, population based cohort study using the QResearch database linked to data on covid-19 vaccination, SARS-CoV-2 results, hospital admissions, systemic anticancer treatment, radiotherapy, and the national death and cancer registries. Settings Adults aged 19-100 years with one or two doses of covid-19 vaccination between 8 December 2020 and 15 June 2021. Main outcome measures Primary outcome was covid-19 related death. Secondary outcome was covid-19 related hospital admission. Outcomes were assessed from 14 days after each vaccination dose. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance was evaluated in a separate validation cohort of general practices. Results Of 6 952 440 vaccinated patients in the derivation cohort, 5 150 310 (74.1%) had two vaccine doses. Of 2031 covid-19 deaths and 1929 covid-19 hospital admissions, 81 deaths (4.0%) and 71 admissions (3.7%) occurred 14 days or more after the second vaccine dose. The risk algorithms included age, sex, ethnic origin, deprivation, body mass index, a range of comorbidities, and SARS-CoV-2 infection rate. Incidence of covid-19 mortality increased with age and deprivation, male sex, and Indian and Pakistani ethnic origin. Cause specific hazard ratios were highest for patients with Down’s syndrome (12.7-fold increase), kidney transplantation (8.1-fold), sickle cell disease (7.7-fold), care home residency (4.1-fold), chemotherapy (4.3-fold), HIV/AIDS (3.3-fold), liver cirrhosis (3.0-fold), neurological conditions (2.6-fold), recent bone marrow transplantation or a solid organ transplantation ever (2.5-fold), dementia (2.2-fold), and Parkinson’s disease (2.2-fold). Other conditions with increased risk (ranging from 1.2-fold to 2.0-fold increases) included chronic kidney disease, blood cancer, epilepsy, chronic obstructive pulmonary disease, coronary heart disease, stroke, atrial fibrillation, heart failure, thromboembolism, peripheral vascular disease, and type 2 diabetes. A similar pattern of associations was seen for covid-19 related hospital admissions. No evidence indicated that associations differed after the second dose, although absolute risks were reduced. The risk algorithm explained 74.1% (95% confidence interval 71.1% to 77.0%) of the variation in time to covid-19 death in the validation cohort. Discrimination was high, with a D statistic of 3.46 (95% confidence interval 3.19 to 3.73) and C statistic of 92.5. Performance was similar after each vaccine dose. In the top 5% of patients with the highest predicted covid-19 mortality risk, sensitivity for identifying covid-19 deaths within 70 days was 78.7%. Conclusion This population based risk algorithm performed well showing high levels of discrimination for identifying those patients at highest risk of covid-19 related death and hospital admission after vaccination. To guarantee the confidentiality of personal and health information, only the authors have had access to the data during the study in accordance with the relevant licence agreements. Access to the QResearch data is according to the information on the QResearch website (). The full model, model coefficients, functional form and cumulative incidence function are published on the qcovid.org website.

中文翻译：

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covid-19 疫苗接种后成人 covid-19 相关死亡和住院的风险预测：全国前瞻性队列研究

目的 推导和验证风险预测算法，以估计英国成年人在接种一剂或两剂 covid-19 疫苗后与 covid-19 相关的死亡率和住院风险。使用与 covid-19 疫苗接种、SARS-CoV-2 结果、住院、全身抗癌治疗、放射治疗以及国家死亡和癌症登记处的数据相关联的 QResearch 数据库，设计基于人群的前瞻性队列研究。设置 在 2020 年 12 月 8 日至 2021 年 6 月 15 日期间接种了一剂或两剂 covid-19 疫苗的 19-100 岁成年人。主要结果指标 主要结果是与 covid-19 相关的死亡。次要结果是 covid-19 相关住院。从每次疫苗接种后 14 天开始评估结果。在推导队列中拟合模型以使用一系列预测变量推导风险方程。在一个单独的一般实践验证队列中评估了性能。结果 在推导队列中的 6 952 440 名接种疫苗的患者中，5 150 310 名 (74.1%) 接种了两剂疫苗。在 2031 例 covid-19 死亡和 1929 例 covid-19 入院中，81 例死亡 (4.0%) 和 71 例入院 (3.7%) 发生在第二次疫苗接种后 14 天或更长时间。风险算法包括年龄、性别、种族、剥夺、体重指数、一系列合并症和 SARS-CoV-2 感染率。covid-19 死亡率随着年龄和贫困、男性以及印度和巴基斯坦种族血统的增加而增加。唐氏综合症（增加 12.7 倍）、肾移植（8.1 倍）、镰状细胞病（7.7 倍）、护理院住院（4.1 倍）、化疗（4.3 倍）、HIV/AIDS（3.3 倍）、肝硬化（3.0 倍）、神经系统疾病（2.6 倍）、最近的骨髓移植或实体器官移植曾经（2.5 倍）、痴呆症（2.2 倍）和帕金森病（2.2 倍）。其他风险增加（增加 1.2 倍至 2.0 倍）的疾病包括慢性肾病、血癌、癫痫、慢性阻塞性肺病、冠心病、中风、心房颤动、心力衰竭、血栓栓塞、外周血管疾病、和2型糖尿病。与 covid-19 相关的住院治疗也存在类似的关联模式。没有证据表明第二次给药后相关性有所不同，尽管绝对风险有所降低。风险算法解释 74。验证队列中 1%（95% 置信区间 71.1% 至 77.0%）的 covid-19 死亡时间变异。歧视性很高，D 统计量为 3.46（95% 置信区间为 3.19 至 3.73），C 统计量为 92.5。每次接种疫苗后的表现都相似。在预测 covid-19 死亡风险最高的前 5% 患者中，识别 70 天内 covid-19 死亡的敏感性为 78.7%。结论 这种基于人群的风险算法表现良好，在识别接种疫苗后 covid-19 相关死亡和住院风险最高的患者方面表现出高度的歧视性。为保证个人和健康信息的机密性，只有作者才能根据相关许可协议在研究期间访问数据。). 完整模型、模型系数、函数形式和累积发生率函数发布在 qcovid.org 网站上。