Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England

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Abstract
COVID-19 is associated with higher rates of gastrointestinal diseases, although the duration of this effect and the roles of vaccination and COVID-19 severity remain uncertain. To investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients. With NHS England approval, OpenSAFELY-TPP was used to access linked data from 24 million English adults. We defined three cohorts: 'prevaccination' (January 2020-June 2021), 'vaccinated' and 'unvaccinated' (June-December 2021). We estimated adjusted HRs (aHRs) comparing the incidence of 10 gastrointestinal diseases, including upper and lower gastrointestinal bleeding, after vs before or without a COVID-19 diagnosis overall and by COVID-19 severity. COVID-19 diagnosis was associated with elevated incidence of gastrointestinal diseases, particularly after hospitalised disease. In the prevaccination cohort (n=18 422 781), the aHRs for upper gastrointestinal bleeding after hospitalised COVID-19 were 20.1 (95% CI 18.4 to 22.1) in weeks 1-4 and 1.90 (1.63 to 2.22) in weeks 53-102. The corresponding aHRs after non-hospitalised COVID-19 were 1.92 (1.74 to 2.11) and 1.34 (1.23 to 1.45), respectively. Across time periods, aHRs for gastrointestinal diseases were lower in vaccinated (n=14 948 727) than in unvaccinated (n=3 479 043) individuals. These patterns were similar across gastrointestinal diseases. The incidence of gastrointestinal disease is elevated for up to 2 years among individuals hospitalised following a COVID-19 diagnosis, especially in the first few weeks after diagnosis. Increases in incidence are attenuated among vaccinated individuals. Monitoring for gastrointestinal diseases after severe COVID-19 and promotion of vaccination in vulnerable groups are key to reducing long-term burden.
Funding Information
  • MRC Integrative Epidemiology Unit at the University of Bristol (MC_UU_00032/03)
  • HDRUK (HDR-23008)
  • BHF Cambridge Centre of Research Excellence (RE/18/1/34212)
  • BHF Cambridge Centre of Research Excellence (RE/24/130011)
  • Bennett Foundation (no award/grant number)
  • EU Horizon programme (No. 101156304)
  • Health Data Research UK South West (HDRUK-2023.0022)
  • Wellcome Trust (222097/Z/20/Z)
  • Wellcome Trust (311535/Z/24/Z)
  • UK NIHR (COV-LT-0009)
  • XTX Markets (no award/grant number)
  • British Heart Foundation (CH/12/2/29428)
  • British Heart Foundation (RG/F/23/110103)
  • NHS England (no award/grant number)
  • NIHR Bristol Biomedical Research Centre, NIHR (NIHR158218)
  • NIHR Bristol Biomedical Research Centre, NIHR (NIHR203315)
  • UKRI MRC (MC/W021358/1)
  • UKRI MRC (MC_PC_20030)
  • UKRI MRC (MC_PC_20051)
  • UKRI MRC (MC_PC_20058)
  • UKRI MRC (MC_PC_20059)
  • UKRI MRC (MR/V015737/1)
  • NIHR Cambridge Biomedical Research Centre (NIHR203312)

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