Evidence map›Paper›PMID 42361406›Full record

ArticleEBioMedicine2026

Factors associated with severe COVID-19 in immunocompromised subgroups in England from 2020 to 2024: an OpenSAFELY cohort study.

Edward P K Parker, Thomas Hartney, Linda Nab, Gayatri Amirthalingam, Nick Andrews, Eleanor V H Barry, Ian J Douglas, Kathryn E Mansfield, Anne Suffel, Meredith Leston and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EBioMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

14 authors.

Edward P K ParkerLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: edward.parker@lshtm.ac.uk.
Thomas HartneyLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Linda NabDepartment of Datascience & Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Gayatri AmirthalingamUK Health Security Agency, London, UK.
Nick AndrewsUK Health Security Agency, London, UK.
Eleanor V H BarryLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
Ian J DouglasLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
Kathryn E MansfieldSchool of Health and Care Sciences, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK.
Anne SuffelLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, UK.
Meredith LestonNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6CG, UK.
OpenSAFELY Collaborative
Brian MacKennaBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK.
William J HulmeBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK.
Laurie A TomlinsonLondon School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIndividuals with compromised immune systems are particularly vulnerable to COVID-19. Although several studies have assessed factors associated with COVID-19-related hospitalisation and mortality in the general population, few studies have focused specifically on immunocompromised populations.

methodsWith the approval of NHS England, we conducted a cohort study using the OpenSAFELY platform covering successive waves of COVID-19 (wave 1, alpha, delta, omicron BA.1/BA.2, JN.1). In each wave, we included adults in five hierarchically assigned immunocompromised subgroups: solid organ transplant (SOT); bone marrow compromise (BMC); active radio- or chemo-therapy (RCT); active immunosuppressive medication (IMM); and primary or acquired immunodeficiency (IMD). In each subgroup, we estimated wave-specific rates of severe COVID-19-related outcomes and relative hazards according to vaccination status, sociodemography (age, ethnicity, deprivation), and comorbidities, as determined at the start of the wave.

findingsWe included between 475,360 (BA.1/BA.2 wave) and 508,545 (JN.1 wave) immunocompromised individuals per wave. Across successive waves, individuals with SOT, BMC, or RCT exhibited higher rates of severe COVID-19 than those with IMM or IMD. Compared with being unvaccinated in the past 26 weeks, vaccination in the 12 weeks preceding the start of a wave was associated with a consistent reduction in severe COVID-19, albeit with a smaller effect size among SOT recipients relative to other subgroups. Though attenuated compared to earlier waves, this association persisted during JN.1 dominance (adjusted hazard ratios of 0.88 [95% CI 0.60-1.30] for SOT, 0.64 [95% CI 0.53-0.77] for BMC, 0.68 [95% CI 0.44-1.03] for RCT, 0.68 [95% CI 0.52-0.88] for IMM, and 0.68 [95% CI 0.55-0.82] for IMD). Older age and increased comorbidity count were strongly associated with increased risk of severe COVID-19 across subgroups and waves.

interpretationThe risk of COVID-19 varies substantially within and across immunocompromised subgroups. The presence of other comorbidities was strongly associated with the risk of severe COVID-19 across successive waves. Primary vaccination and successive booster doses were associated with a consistent reduction in severe COVID-19 in this high-risk population, including during the JN.1 wave.

fundingNational Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation (NIHR200929/NIHR207408).

Indexed as

COVID-19Immunocompromised HostAdultAgedCohort StudiesComorbidityEnglandFemaleHumansMaleMiddle AgedRisk FactorsSARS-CoV-2Severity of Illness IndexBurdenCOVID-19ImmunocompromiseImmunosuppressionVaccine

Identifiers

PMID42361406
PMCPMC13324492

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.