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Does COVID-19 Vaccination Decrease Risk for Death From Other Causes?

  • Authors: WebMD News Author: Carolyn Crist; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 12/3/2021
  • Valid for credit through: 12/3/2022
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

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Target Audience and Goal Statement

This activity is intended for primary care clinicians, nurses, pharmacists, and other members of the healthcare team who care for patients who are eligible for the COVID-19 vaccine.

The goal of this activity is to assess the effect of the COVID-19 vaccine on the risk for death due to non--COVID-19 causes.

Upon completion of this activity, participants will:

  • Analyze research of a booster dose for COVID-19 vaccine among older adults
  • Assess the effect of COVID-19 vaccination on mortality because of causes other than COVID-19
  • Outline implications for the healthcare team


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WebMD News Author

  • Carolyn Crist


    Disclosure: Carolyn Crist has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/CME Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

CE Reviewer

  • Esther Nyarko, PharmD

    Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

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Does COVID-19 Vaccination Decrease Risk for Death From Other Causes?

Authors: WebMD News Author: Carolyn Crist; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 12/3/2021

Valid for credit through: 12/3/2022


Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to COVID-19 vaccines may be provided in this activity to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The application of booster doses of the COVID-19 vaccine has received a large amount of attention in the media in the United States, and booster doses are now recommended for all patients who received the Johnson & Johnson/Janssen vaccine as well as individuals at high risk for complications of COVID-19 who received one of the mRNA-based vaccines. The best evidence for the efficacy of booster doses comes from a study in Israel, where the Pfizer/BioNTech vaccine was approved as a booster for adults at age 60 years and older on July 30, 2021. Bar-On and colleagues published the results of this study in the October 7, 2021 issue of the New England Journal of Medicine.[1]

Data were available for more than 1 million adults who had received at least 2 doses of an mRNA-based COVID-19 vaccine. Compared with participants who had just 2 doses of the Pfizer/BioNTech vaccine, the application of a booster was associated with an 11-fold reduction in the risk for COVID-19, as well as a near 20-fold reduction in the risk for severe COVID-19.

There are many adults who remain unconvinced of the effectiveness of COVID-19 vaccines. The results of the current study by Xu and colleagues may help to change their minds.

Study Synopsis and Perspective

People who have been vaccinated against COVID-19 are not only less likely to die from the virus, but they are also less likely to die from any cause in the months after vaccination, according to a new study.

The study team, which included researchers from the CDC and health care groups across 7 states, found the results while studying the safety of the 3 authorized COVID-19 vaccines.

The results were published October 29 in the CDC’s Morbidity and Mortality Weekly Report.[2]

“COVID-19 vaccines authorized in the United States have shown again and again to be safe. This study also confirms their safety,” Stanley Xu, who led the study team and is a researcher at the Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, told CNN.[3]

“In fact, it shows that people vaccinated for COVID-19 had lower death rates than those who were not vaccinated, even when COVID deaths were excluded,” he said. “That’s in addition to the mounting evidence from other studies showing that the COVID-19 vaccines are effective against COVID-19 infection, serious illness, and death.”

The research team studied 11 million people, including 6.4 million people who had been vaccinated against COVID-19 and 4.6 million people who had received flu shots in recent years but had not received a COVID-19 vaccine. They filtered out anyone who had died from COVID-19 to analyze the noncoronavirus deaths.

Between December 2020 and July 2021, COVID-19 vaccine recipients had lower rates of non--COVID-19 mortality than unvaccinated people, including adjustments for age, race and ethnicity, sex, and geographic location.

Persons who received 2 doses of the Pfizer vaccine were 34% as likely to die from noncoronavirus causes in the months after vaccination as unvaccinated people. Persons who received 2 doses of the Moderna vaccine were 31% as likely to die as unvaccinated people, and persons who received the 1-shot Johnson & Johnson vaccine were 54% as likely to die.

One explanation could be that people who get vaccinated, in general, tend to be healthier than people who do not, the researchers said, noting that they plan to study this more in the future.

“There is no increased risk for mortality among COVID-19 vaccine recipients,” they wrote. “This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States.”

More than 222 million people in the United States have received at least 1 COVID-19 vaccine dose, according to the latest CDC data updated November 4, 2021.[4] More than 78% of ages 12 years and older have received a shot, and 67% are considered fully vaccinated.

Study Highlights

  • Researchers collected study data from the US Vaccine Safety Datalink, which collects national data on vaccines and health events. The current study focused on persons in the database who were ≥ 12 years old and had COVID-19 vaccination status documented by May 31, 2021.
  • Individuals who received the COVID-19 vaccine were compared with persons who did not get the vaccine. To reduce any disparity in healthcare exposure, only individuals who received ≥ 1 dose of the influenza vaccine in the past 2 years were considered in the control cohort.
  • The main study outcome was the comparison of individuals who received and did not receive the COVID-19 vaccine with regard to deaths not due to COVID-19. These deaths were defined by no diagnosis of COVID-19 or positive test for SARS-CoV-2 in the 30 days before the date of death.
  • The study analysis was adjusted for age, sex, and race/ethnicity.
  • Investigators compared 6.4 million vaccine recipients with 4.6 million individuals who were unvaccinated. Demographic characteristics were similar in the vaccinated and unvaccinated cohorts. Most study participants were female, and ~ 70% of participants were between the ages of 18 and 64 years.
  • Standardized mortality rates after dose 1 of the Pfizer/BioNTech and Moderna vaccines were 0.42/100 person-years (PY) and 0.37 deaths/100 PY, compared with a rate of 1.11/100 PY in the unvaccinated group. The respective adjusted relative risks (ARRs) for death unrelated to COVID-19 after dose 1 of the Pfizer/BioNTech and Moderna vaccines vs the unvaccinated group were 0.41 (95% CI: 0.38, 0.44) and 0.34 (95% CI: 0.32, 0.37).
  • The respective ARRs for non--COVID-19 mortality for the second dose of Pfizer/BioNTech and Moderna vaccines were 0.34 (95% CI: 0.33, 0.36) and 0.31 (95% CI: 0.3, 0.33).
  • The overall mortality rate among participants who received the Johnson & Johnson/Janssen vaccine was 0.84/100 PY compared with a rate of 1.47/100 PY in the unvaccinated group (ARR = 0.54 [95% CI: 0.49, 0.59]).
  • Overall, the mRNA-based vaccine was most effective in the prevention of non--COVID-19 mortality among individuals at age ≥ 65 years.
  • All vaccine types were similarly effective in mortality outcomes among women and men. All vaccinated racial/ethnic groups fared better in mortality outcomes compared with unvaccinated groups.

Clinical Implications

  • A previous cohort study by Bar-On and colleagues found that a booster dose of the Pfizer/BioNTech vaccine was associated with lower incidence rates of COVID-19, with an even more profound effect on reducing the risk for severe COVID-19.
  • The current study by Xu et al suggests that all COVID-19 vaccines can reduce the risk for mortality not related to COVID-19. This effect was more profound with the mRNA vaccines and was found in all racial/ethnic groups.
  • Implications for the healthcare team: The healthcare team can use the results of the current study to suggest another potential benefit of COVID-19 vaccination for patients who lack vaccine enthusiasm.


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