Association between COVID-19 vaccination and first healthcare utilization for chronic obstructive pulmonary disease: A nationwide population-based cohort study

Abstract

Background: Uncertainties about the impact of coronavirus disease 2019 (COVID-19) vaccination on chronic obstructive pulmonary disease (COPD) have been increasing. Thus, this study aimed to investigate the association between COVID-19 vaccination and COPD. Methods: We conducted a cohort study using COVID-19 immunization registry data. The exposure was COVID-19 vaccination status, and the outcome was first healthcare utilization for COPD. Cox proportional hazards models were used to assess the risk of first healthcare utilization for COPD. Results: Of the 27,595,469 individuals, 93.9 % had received COVID-19 vaccination. The risk of first healthcare utilization for COPD was significantly lower in vaccinated participants than in unvaccinated participants (hazard ratio [HR] = 0.46, 95 % confidence interval [CI] = 0.46–0.47). The decreased risk was more evident for first emergency room visits or hospitalizations for COPD (HR = 0.24, 95 % CI = 0.24–0.25). In the subgroup analysis, the decreased risk of first healthcare utilization for COPD was less significant in participants with frequent healthcare utilization, including the elderly, women, medical aid recipients, and those with comorbidities, than their counterparts. Of these, the smaller magnitude of the inverse association was observed in the pulmonary tuberculosis and asthma group. Regarding vaccination subtypes, the reduction was more prominent among those with a single vaccination (HR = 0.27, 95 % CI = 0.26–0.29) and mRNA recipients (HR = 0.35, 95 % CI = 0.35–0.36). Conclusions: COVID-19 vaccination is associated with a decreased risk of first healthcare utilization for COPD, particularly concerning mRNA vaccine and emergency room visits or hospitalizations. Among frequent healthcare utilizers, the effect of vaccination is more pronounced in individuals with pulmonary tuberculosis or asthma than in those without pulmonary tuberculosis or asthma. © 2025 Elsevier Ltd