Demographic and clinical characteristics of primary care patients vaccinated against Covid-19 in spring 2021

At the end of December 2020, Germany began vaccinating the population against Covid-19. By February 2021, several vaccines had already been approved in many countries including Germany [1]. However, until June 2021, the Covid-19 vaccination could only be offered to certain groups of people due to limited vaccine availability. The prioritization was based on the level of risk of severe or fatal courses of Covid-19 disease as well as on the basis of occupational exposure or close contact with vulnerable groups of people. The highest priority was, among others, people over 80 and employees of medical facilities or retirement homes. High priority included people over 70 and people with defined serious chronic illnesses (e.g. dementia or mental disability). Increased priority was given to people over 60 and people with other illnesses (e.g. diabetes mellitus or stroke) [2]. In addition, close contacts of those in need of care and pregnant women had to be prioritized. The vaccination prioritization was lifted nationwide for all vaccines on June 7, 2021. Studies conducted in Germany in 2021 showed a high acceptance rate among healthcare workers [3] and among older people [4].

>> After vaccination only took place in the vaccination centers in the first few months, from April 2021 onwards doctors in private practice were integrated into the vaccination campaign across the board [5,6]. As early as May 2021, the prioritization for a first vaccine and, followed by the Covid-19 vaccination, was gradually released for general practitioners depending on the federal state. From an epidemiological and medical-sociological perspective, the relevant question is which people were actually vaccinated in the first few months before the end of prioritization by general practitioners. No studies have been published on this to date. In order to close this gap, the authors examined the age structure and comorbidities of the people vaccinated in general practitioner practices in April and May 2021.
methods
This cross-sectional study was based on electronic patient data from the Disease Analyzer Database (IQVIA), which collects drug prescriptions, diagnoses, and general medical and demographic data obtained directly in anonymized form from the computer systems used in the practices of general practitioners and specialists. Diagnoses, prescriptions and the quality of reported data are monitored by IQVIA based on a number of criteria. The coverage of this database is around 3% of all established practices in all federal states in Germany. The sampling methods used in Germany to select medical practices have proven to be suitable for obtaining a population-representative database of primary and specialty care [7].
The analysis included patients who received their first Covid-19 vaccination in April or May 2021 from one of the 820 GP practices that routinely send data to the Disease Analyzer database. Vaccinations were identified using the EBM (uniform evaluation standard) performance figures, which allow assignment to three indications (general indication, occupational indication and nursing home residents).
The analyzes related to indication, age structure (up to 30, 31-40, 41-60, 61-70, 71-80, >80), gender, co-diagnoses and comorbidity (0, 1, 2, >2 different diseases ). Diagnoses included all diseases mentioned in the prioritization lists, including Down syndrome, dementia or severe psychiatric illness (depression, schizophrenia, bipolar disorder), chronic liver disease, cancer, chronic lung disease (COPD, asthma, cystic fibrosis), diabetes mellitus, and obesity , chronic kidney disease, heart disease (ischemic heart disease, heart failure, atrial fibrillation), autoimmune diseases (multiple sclerosis, rheumatoid arthritis, Crohn's disease, ulcerative colitis, spondylitis, lupus, psoriasis, Hashimoto's disease, Addison's disease, Cushing's disease), arterial hypertension.
In vaccinated people who did not have a diagnosis from the priority list, further diagnoses (anaemias, thyroid diseases, vitamin D deficiency, hypercholesterolemia, anxiety disorder and post-traumatic stress disorder, chronic headaches, mono- and polyneuropathies, venous diseases, allergies and chronic rhinitis, chronic Stomach diseases) checked.
This is a descriptive evaluation without complex statistical analyses.
Results
A total of 245,948 people were available for analyses, which were carried out for the first time in April or May 2021
received Covid-19 vaccination. A total of 121,032 women (49.2%) and 124,926 men (50.8%) were recorded. The average age of all those vaccinated was 59.9 years (women 61.5 years, men 58.4 years).
230,299 (93.6%) people received a vaccination based on the so-called general indication, 15,154 (6.2%) based on the occupational indication, and only 505 (0.2%) were nursing home residents. Figure 1 shows the age structure of people with general indications. On average, men were 3.5 years younger than women. Figure 2 shows the proportion of women and men under the age of 60 with diagnoses from the priority list. 46.3% of women and 48.4% of men did not have any of the diagnoses from the priority list. The distribution of diagnoses is shown in Figure 3. Hypertension was the most common diagnosis (23.6% for men and 20.7% for women). In men, a chronic respiratory disease such as COPD or asthma was the second most common diagnosis.
gnosis (11.0%), while depression (17.0%) was the second most commonly diagnosed diagnosis in women.
A detailed analysis of the patients without diagnoses from the priority list showed that 30,2% of them had at least one other chronic disease. The most common diagnoses were chronic gastric disease (7.5%), allergic rhinitis or chronic sinusitis (7.5%), or thyroid disease (6.3%).
A monthly analysis of the months of April and May 2021 showed the following picture: In April, 10.8% were younger than 60 years and without relevant diagnoses, while in May this proportion was 30.6%.
discussion

This cross-sectional study includes almost 246,000 patients with a vaccination against Covid-19 from 820 general practitioners' practices in Germany. The study was carried out with general practitioners' practices, as they also carry out regular vaccinations of the population and should enable a good representativeness of patients in Germany. The study found that 94% of the people were vaccinated based on the general indication. It was also found that more than half of these people were over 60 years old and were therefore eligible to be vaccinated based on their age. Among younger people, half had one of the chronic diseases mentioned in the vaccination priority list. In addition, several people had other chronic illnesses. Nevertheless, none of the known chronic diseases could be diagnosed in a third of the vaccinated patients under the age of 60. To the authors' knowledge, this is the first or one of the first largest studies to examine demographic and clinical characteristics of people vaccinated against Covid-19 by primary care physicians. It is known from reports from family doctors that there were numerous problems in the first weeks of the vaccination campaign, for example problems with deliveries of vaccines (eg 8).
In addition, family doctors had to put a lot of effort into organizing, informing and advising patients (9). Nevertheless, especially thanks to family doctors, more and more people were able to be vaccinated faster and faster. Our data shows that older and sick people in particular were vaccinated by general practitioners during the observation period, while people with professional indications and nursing home residents, for example, made up a small proportion. At this point, nursing home residents were most likely already being vaccinated by mobile teams directly in nursing homes, while people with professional indications were vaccinated directly in the clinics and vaccination centers.
We were unable to get some of the vaccinated people
Assign priority group. There may be various reasons for this proportion, which at the same time represent limitations of our study. First, we only looked at common diseases.
There are more than 100 rare, serious illnesses that warrant earlier Covid vaccination. Secondly, it must be taken into account that the vaccination process was dependent on dynamic, sometimes very volatile scientific, social and political conditions. The guidelines that general practitioners should follow changed repeatedly; The vaccination prioritization for the Covid-19 vaccine from AstraZeneca was lifted relatively early, which meant that a large number of people who did not belong to any priority group could be vaccinated immediately. It is not easily possible to distinguish which vaccine was used and was not analyzed in this study. Thirdly, at the end of May, the vaccination prioritization was largely lifted for the general practice area, which made it possible to vaccinate patients without prioritization. Unfortunately, information about serious illnesses or the need for care of family members or contact persons, which represent an indication for vaccination, is also missing. The analysis at the monthly level reflects the gradual lifting of prioritization in the private sector. The proportion of patients who could not be assigned to a prioritization group increased from 11% in April to 31% in May. Finally, when assessing vaccinations, changes in attitudes in the population towards individual vaccines and the Covid-19 vaccination as a whole must also be taken into account (10).
Missing data could be identified through surveys in future studies. Further studies that compare vaccinated and unvaccinated people in terms of their characteristics would also be of great epidemiological relevance. <<