COVID-19 vaccination and mortality in young people during the coronavirus pandemic

• There is currently no evidence of a change in the number of cardiac-related deaths or death occurring from any cause after a coronavirus (COVID-19) vaccination in young people aged 12 to 29 years in England.

• More deaths were registered in young people aged 15 to 29 years in England in 2021 than the average number registered in 2015 to 2019; however, there was no excess in 2021 for deaths from circulatory diseases.

• We do not yet have a complete picture of how the coronavirus pandemic has affected deaths in young people, because it takes a long time to investigate deaths from external causes; we will continue to monitor the safety of vaccines and the changes in excess deaths.

• Early indications show deaths in 2020 increased for some causes, particularly suicides in young females and accidental poisonings (mostly drug poisonings) in young males.

On 8 December 2020, the UK began administering vaccines against SARS-CoV-2 according to the priority groups determined by the Joint Committee on Vaccination and Immunisation (JCVI). The vaccines have had high effectiveness against death and hospitalisation and have saved thousands of lives worldwide.

However, the safety of these vaccines is still of concern. An extensive international programme of surveillance and research monitors potential adverse effects. The overall picture is reassuring, but there are some reports of potential side effects, including an alleged association between vaccination and mild myocarditis and myopericarditis in young people.

Deaths in people aged 15 to 29 years are relatively rare. Our Deaths registered in England and Wales dataset shows there were around 3,600 such deaths in England each year in the years preceding the coronavirus (COVID-19) pandemic. More deaths were registered in England in 2021 in people aged 15 to 29 years compared with the average for the five years preceding the coronavirus pandemic. It is important to investigate potential causes of this excess of death registrations, and consider any possible connection with the vaccination programme.

To assess whether the deaths of young people in 2021 were temporally linked with receiving a COVID-19 vaccination, we compared the number of deaths in two time periods; these were weeks one to six following vaccination (risk period) and weeks 7 to 12 following vaccination (baseline period). Myocarditis tends to appear very soon after vaccination, with evidence suggesting the median time from vaccination to symptom onset is two days. However, we used the first six weeks after vaccination as the risk period to ensure that all deaths resulting from myocarditis would be captured. The number of follow up weeks was restricted to 12 to minimise the impact of registration delay, where deaths that occurred in later calendar weeks were less likely to have been registered. See the Data sources and quality section for more detail.

We analysed deaths of vaccinated people aged 12 to 29 years that occurred up to 2 February 2022 and were registered by 16 February 2022, and vaccinations that were recorded up to 2 February 2022.

In this self-controlled case series study (see Glossary), we estimated the incidence rate ratio of cardiac-related death (ICD-10 code I30-I52 mentioned on the death certificate) and all cause deaths, comparing deaths in the risk period with deaths in the baseline period. We examined these ratios for each of the six individual weeks in the risk period as well the six weeks as a whole.

585 young people aged 12 to 29 years died within 12 weeks of receiving a dose of a COVID-19 vaccine.

Figure 1: There was no change in the risk of cardiac death in the risk period after vaccination among those aged 12 to 29 years

Relative incidence of cardiac and all cause deaths in each of the six weeks in the risk period and in the risk period as a whole compared with the baseline period, England, up to 16 February 2022

Notes:

1. Error bars give 95% confidence intervals (see Glossary).

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There was no evidence of a change in the risk of cardiac-related death in any of the first six weeks in the risk period after vaccination or in the risk period as a whole. The risk of death in the first six weeks after vaccination was 0.99 times (95% confidence interval 0.67 to 1.46) that of the risk in the baseline period. Therefore, there is no statistically significant difference.

There was also no evidence of an elevated risk of all cause death in any of the first six weeks in the risk period after vaccination, and no change in the risk of all cause death in the risk period as a whole (relative incidence 0.94, 95% confidence interval 0.79 to 1.10). A decrease in the risk of death for all causes was observed in the first week after vaccination (0.50, 0.33 to 0.74).

This may reflect the "healthy vaccine effect", where people who are unwell are more likely to delay vaccination until recovered. Therefore, the health of people who have recently received a vaccination is generally better than those who have been vaccinated for a longer time.

There was also no evidence of a change in the risk of cardiac-related death or death from any cause for any of the subgroups analysed (those aged 12 to 17 years, those aged 18 to 24 years, and those aged 25 to 29 years, males, and females) or by dose or vaccine type they received (see dataset).

This analysis therefore does not indicate any increased risk of cardiac-related deaths or deaths owing to any cause following vaccination. To explore this further, we compared excess deaths in young people in 2021 with earlier years.

In young people aged 15 to 29 years in England, there were more deaths registered in 2021 compared with the average in the five years preceding the coronavirus (COVID-19) pandemic, 2015 to 2019 (Table 1). The number of excess deaths in this age group in 2021 was higher for males than females (113 and 66 deaths, respectively). In females aged 15 to 19 years, there were no excess deaths.

Although the number of death registrations was higher in 2021 than the pre-coronavirus pandemic average, the number registered in 2020 was lower than the pre-coronavirus pandemic average for both sexes and across all groups aged 15 to 29 years (Table 1).

The fall in death registrations in 2020 and subsequent increase in 2021 could be explained by the known disruption to the operation of coroners' courts during the coronavirus pandemic, particularly the first lockdown in spring 2020. Deaths are generally not registered until after the coronial process is complete. Therefore, delays will particularly affect deaths from those causes that are most likely to be referred to the coroner, such as deaths from external causes.

To examine this hypothesis further, numbers of death registrations are presented for each sex in Tables 2A and 2B by selected underlying causes of death, for deaths in those aged 15 to 29 years.

The excess death registrations in 2021 in those aged 15 to 29 years were largely owing to external causes and deaths from COVID-19 (Table 2A and 2B). However, there was also a fall in death registrations from external causes in 2020. Therefore, it is likely that these trends are heavily influenced by delays to the coronial process.  

Deaths with an underlying cause of myocarditis or pericarditis would be counted in the "diseases of the circulatory system" category. However, there was not an excess of death registrations in 2021 in that category for either sex compared with the annual average for 2015 to 2019.

To illustrate the impact of registration delays on specific causes, Figure 2 shows deaths that were registered in 2021 by the year in which they occurred. For deaths of people aged 15 to 29 years from all causes registered in 2021, only 56% occurred in that year; 32% occurred in 2020 and 11% occurred in earlier years.

Deaths from external causes take longer to be registered than other deaths. For land transport accidents, for example, only 22% of deaths that were registered in 2021 actually occurred in that year. For deaths from homicide or probable homicide, 30% of deaths registered in 2021 occurred in 2019 or earlier years. For deaths from suicide, that figure was 14%.

Deaths from circulatory disease are less likely to be referred to the coroner. 98% of deaths that were registered in 2021 for ages 15 to 29 years occurred either in that year or 2020 (Figure 2).   

Because of the impact of registration delays, analysis for external causes was repeated using year of occurrence, rather than year of registration. Figure 2 shows that for leading external causes, fewer than half of deaths registered in 2021 actually occurred in that year. It is therefore too early to look at numbers of cause specific deaths that occurred in 2021, because for some causes, the majority are likely yet to be registered. Numbers for 2020 will be more complete, but not all deaths that occurred in 2020 will yet have been registered.

To account for unregistered deaths, an adjustment was made to numbers of deaths in 2020. For deaths occurring in 2017 (the most recent pre-coronavirus (COVID-19) pandemic year for which most deaths will have been registered), the numbers registered by the end of January 2019 were extracted. This was done for specific age and sex groups, and done separately for selected underlying causes (because Figure 2 shows that registration delays vary between causes). These numbers were then compared with the numbers of deaths that occurred in 2017 and were registered by the end of January 2022. This allows us to calculate the percentage of deaths that were unregistered by the end of January 2019.

These percentages were used to adjust the number of deaths that occurred in 2020 and were registered by the end of January 2022. As the adjusted numbers are based on registration delays in the pre-coronavirus pandemic period, they should be regarded as the estimated minimum number of occurrences that could be expected once registrations are complete.  

For males aged 25 to 29 years, the adjusted counts for 2020 show a total excess for all cause deaths to be 27 more than the average for 2015 to 2019. For males aged 15 to 19 years and aged 20 to 24 years, the adjusted 2020 counts for all causes remained below the pre-coronavirus pandemic average (Table 3A).

By cause, the adjusted numbers for 2020 show an excess for accidental poisoning deaths for males aged 15 to 24 years. As Table 2 indicates, the majority of these will have been caused by accidental drug poisoning.

Adjusted numbers for male suicides in 2020 were similar to the pre-coronavirus pandemic average for those aged 20 to 29 years, and lower for those aged 15 to 19 years. For land transport accidents, adjusted numbers for 2020 remained lower than the pre-coronavirus pandemic average for males in all three age groups. Numbers for these causes may increase, however, as more registrations are completed for deaths that occurred in 2020.   

For females, adjusting the numbers of deaths occurring in 2020 to account for unregistered deaths resulted in a small overall excess for those aged 20 to 24 years, and a slightly larger one for those aged 25 to 29 years (Table 3B).

In all three age groups, the number of female suicides occurring in 2020 that are already registered was higher than the pre-coronavirus pandemic average, and adjusting the numbers increased the size of this excess further. The biggest excess was for females aged 25 to 29 years, where the adjusted number showed 31 more suicides in 2020 when compared with the average for 2015 to 2019.

For other external causes for females, adjusted numbers in 2020 were similar to, or lower than, the pre-coronavirus pandemic average.

Coronavirus (COVID-19)

Refers to the "coronavirus disease 2019" and is a disease that can affect the lungs and airways. It is caused by a type of coronavirus. Further information is available from the World Health Organization (WHO). 

Self-controlled case series

The self-controlled case series (SCCS) is a method developed to study adverse reactions to vaccines. This method compares the incidence of the outcome in a risk period (weeks one to six after vaccination) with a baseline period (weeks 7 to 12 after vaccination) to assess whether there is a change in the risk of death soon after vaccination compared with later after vaccination. 

95% confidence intervals 

A confidence interval is a measure of the uncertainty around a specific estimate. If a confidence interval is 95%, it is expected that the interval will contain the true value on 95 occasions if repeated 100 times. As intervals around estimates widen, the level of uncertainty about where the true value lies increases. The size of the interval around the estimate is strongly related to the number of deaths, prevalence of health states, and the size of the underlying population. At a national level, the overall level of error will be small compared with the error associated with a local area or a specific age and sex breakdown. More information is available on our Uncertainty and how we measure it for our surveys page. 

Relative incidence 

In this study, the relative incidence is a measure of the relative differences in the number of deaths in different groups. A relative incidence greater than one indicates the incidence of death is higher in a given period, compared with a baseline period. Likewise, a relative incidence less than one indicates the incidence of death is lower in a given period.

The analysis of death following vaccination in young people is based on linked death registration data from the Office for National Statistics (ONS) to data on COVID-19 vaccination from the National Immunisation Management Service (NIMS) and an extract from NHS point of care data provided by NHS-Digital.

The NIMS data includes most COVID-19 vaccinations administered in England since 8 December 2020. However, in some rare cases, the vaccination records of people who died shortly after vaccination may not be recorded in NIMS. This would happen if the death was recorded on the Personal Demographics Service (PDS) before the vaccination records were sent to NIMS. Therefore, we supplemented the vaccination records from NIMS using a special extract of 2,044 people people who died after vaccination but whose records for the last vaccination received were not sent to NIMS.

Two of these were aged 12 to 29 years and had a linked death record. The linkage was conducted using NHS number, which was available for 99.96% of NIMS records, 99.6% of deaths and 100% of the extract from NHS Digital.

The data covers people residing in England and included deaths that occurred between 8 December 2020 and 2 February 2022 and were registered by 16 February 2022, and vaccinations that were recorded up to 16 February 2022.

We used a self-controlled case study design, which compares the incidence rate of the outcome in a risk period to a baseline period. This helps us assess whether there is a change in the risk of death soon after vaccination compared with later after vaccination.

Follow up started on the day of last vaccination received. Participants were not censured if a death occurred, but were followed for 12 weeks after vaccination or a whole number of weeks until the end of study if sooner. The number of follow up weeks was restricted to 12 to minimise the impact of registration delay, where deaths that occurred in later calendar weeks were less likely to have been registered. We analysed cardiac-related death (ICD-10 code I30-I52 mentioned on the death certificate) and deaths owing to all causes.

The self-controlled case series models were fitted using a conditional logistic regression model on a person-week level, with an individual effect. Incidence rate ratios, the relative rate of cardiac-related or all cause deaths in risk periods relative to baseline periods, and their 95% confidence intervals were estimated using each model. Clustered standard errors accounted for multiple measurements per participant.

These analyses were conducted in collaboration with analysts from the Office for Health Improvement and Disparities (OHID), in particular Allan Baker, Leigh Fowler-Dowd and Ed Klodawski.