Does COVID-19 Vaccination Status Shape Avoidable and Non-Avoidable Mortality? Insights from a Czech Population-Based Study (2022–2024)

Klara Hulikova Tesarkova , Charles University, Prague, Czechia
Dagmar Dzurova, Charles University, Faculty of Science

The COVID-19 pandemic had a significant impact on mortality and public health, with vaccine resistance emerging as a notable challenge. While vaccination has been proven to decrease mortality and severe outcomes from COVID-19, less is known about differences in mortality from other causes among vaccinated and unvaccinated groups. This study analyses individual-level data from the Czech National Information System of Infectious Diseases (ISID) and mortality records (2020–2024), covering nearly 7.5 million adults who were (at least once) tested for COVID-19 or vaccinated. Using Cox regression with competing risks, the research focuses on three aims: (1) evaluate differences in mortality risk from selected non-COVID-19 causes according to vaccination status, (2) evaluate differences in avoidable and non-avoidable mortality according to vaccination status, and (3) evaluate trends in mortality differences over time, where their stability would prove for stability of behavioural or lifestyle differences. Findings show an 18-fold higher risk of COVID-19 mortality for never-vaccinated individuals compared to vaccinated ones in 2022. Other causes of death also exhibit statistically significant differences, with 3- to 4-fold risks for respiratory diseases, some types of dementia, hypertension, or diabetes. More minor differences were observed for specific malignant neoplasms and external causes of death. Avoidable mortality risks were 1.5- to 2-fold higher among unvaccinated individuals, while non-avoidable mortality showed no significant differences. Persistent mortality disparities over subsequent years suggest that vaccine refusal reflects broader behavioural and lifestyle differences. Efficiently targeted information campaigns for vaccine-resistant populations could help to reduce overall mortality and health inequalities.

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 Presented in Session P5. Health, Mortality, and Ageing 1