Coronavirus and vaccination rates in adults by socio-demographic characteristic and occupation, England: December 2020 to March 2023

• Among people aged 18 and over, 75.8% had received at least three coronavirus (COVID-19) vaccinations as of 2 March 2023; of those who had received three doses and were eligible, 77.7% had continued to their fourth vaccination.

• Older people were more likely to continue to their fourth vaccination than younger people, with 94.0% of people aged 80 years and over receiving a fourth dose, compared with 66.4% in people aged 50 to 59.

• After adjusting for differences in age, the ethnic groups with the lowest proportion of people continuing to a fourth vaccination were Pakistani (34.8%), Bangladeshi (36.3%), and Black African (41.8%), compared with the White British group (78.1%); the Pakistani and Black African groups were among the lowest uptake of the third vaccination (40.9% and 42.4%, respectively), and far fewer Bangladeshis had continued to a fourth dose (53.1% receiving three doses).

• Among the eligible population, people identifying as Jewish had the highest proportion of people continuing to a fourth vaccination (80.7%), with those identifying as Muslim having the lowest continuation from third to fourth dose (36.6%).

• People living in the most deprived areas were least likely to continue to a fourth vaccination (63.8%), with vaccination rates increasing as deprivation reduces. Similarly, people in higher managerial occupations had the highest continuation from third to fourth dose (80.7%).

• People reporting fair health (77.8%) were the highest proportion of people continuing from a third to a fourth vaccination; individuals in very good health (71.8%) had the lowest continuation from third to fourth dose, followed by those in very bad health (73.1%).

The continuation from third to fourth dose of the coronavirus (COVID-19) vaccine was highest among individuals aged 80 years and above (94.0%) and those between the ages of 70 and 79 years (91.9%). Younger age groups had lower continuation, with less than half of eligible individuals aged 18 to 29 years (38.6%) and 30 to 39 years (44.1%) receiving their fourth dose.

The White British ethnic group had the highest rate of continuation from third to fourth dose of the COVID-19 vaccine (78.1%) among eligible adults. This was followed closely by people identifying as Chinese (72.4%) and White other (65.0%). In contrast, among eligible adults, there was particularly low continuation to the fourth vaccination in the Pakistani (34.8%), Bangladeshi (36.3%), and Black African (41.8%) ethnic groups.

The continuation from third to fourth vaccination was highest among people identifying as Jewish (80.7%), Christian (78.9%), or having no religion (71.4%). However, less than half of the eligible Muslims (36.6%) have continued to a fourth vaccination. People who identify as Sikh (52.8%) also have low continuation. This trend was consistent with the uptake of third vaccinations, where people identifying as Muslim or Sikh also had the lowest uptake.

The proportion of eligible individuals who had continued to their fourth vaccination was lowest among the most deprived areas (63.8%), and highest among the least deprived areas (81.5%). Area deprivation was measured according to the English index of multiple deprivation of an individual's area of residence.

Differences in third to fourth vaccination continuation are small, when measured by highest qualification. Individuals with apprenticeships (78.6%) or Level 4 qualifications (76.2%) have the highest continuation. People with Level 3 qualifications (72.3%) have the lowest continuation. For more information on qualification definitions, see our Highest level of qualification definitions.

The highest proportion of individuals continuing from a third to a fourth vaccination were people in the most advantaged NS-SEC class, in higher managerial, administrative, and professional occupations (80.7%). Those in routine occupations (71.4%) and small employers and own account workers (71.5%) had the lowest continuation to fourth vaccinations. For more information on socio-economic classifications, see our SOC 2020 Volume 3: the NS-SEC methodology.

For individuals aged 60 years and above, the continuation from third to fourth vaccination was lowest among those who report they are reduced a lot by their long-term health condition or disability. People who have long-term health issues or a disability but are not reduced at all had the highest continuation for all age groups, from age 40 years and above. Among individuals aged 59 years and younger, continuation to the fourth dose was lowest for those with no self-reported long-term health conditions.

Eligible individuals in very good health have the lowest continuation to the fourth vaccination (71.8%), followed by people reporting to be in very bad health (73.1%). Fourth vaccination rates were highest among the eligible population who reported to be in fair health (77.8%).

Coronaviruses

The World Health Organization (WHO) defines coronaviruses as "a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)". Between 2001 and 2018, there were 12 deaths in England and Wales because of a coronavirus infection, with a further 13 deaths mentioning the virus as a contributory factor on the death certificate.

Coronavirus (COVID-19)

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).

We used Census 2021 to provide an anonymised person-level dataset on which health, vaccination, and mortality datasets could be linked. The Census 2021 dataset comprised individuals enumerated in Census 2021, who could be linked to an NHS number in the Personal Demographics Register, with a linkage rate of 91.1%.

There were 52 million individuals in this dataset who were usual residents in England, which covered approximately 91.7% of the population of England on Census Day 2021. These individuals were linked to vaccinations data from:

• the National Immunisation Management Service (NIMS)

• a supplementary extract from NHS-Digital point of care

• mortality data from Office for National Statistics (ONS) death registrations

• health data from Hospital Episode Statistics (HES)

• the General Practice Extraction Service (GPES) data for Pandemic Planning and Research version 3 (GDPPR)

There were 1,069 vaccination records from the NHS-Digital point of care extract, covering records up to 29 January 2023, which provided additional vaccination records when linked to our Census 2021-based dataset. The English index of multiple deprivation is linked using the census-reported household output area.

The study consisted of people:

• aged 18 years and over

• alive on 2 March 2023 who were resident in England

• enumerated to Census 2021

• eligible for a fourth vaccination as part of the autumn 2022 booster campaign, or who received three doses as part of their primary course and therefore received a fourth vaccination in the autumn 2021 vaccination campaign

This included:

• all adults aged 50 years and older

• residents and staff in care homes

• frontline health and social care workers

• individuals who are in a clinical risk group

• people who are immunosuppressed or household contacts with immunosuppressed individuals

• carers

The linked NIMS and supplementary extract from NHS-Digital contains flags to determine eligibility for the fourth vaccination.

The age-standardised proportions presented are annualised directly age-standardised rates per 100 people, represented as a percentage. This is the number of people who have received a vaccination divided by the population for the relevant time period, standardised to the European Standard Population, multiplied by 100.

All individual-level socio-demographic characteristics were derived from Census 2021. These characteristics are:

• sex

• ethnic group

• religious affiliation

• disability status

• educational attainment

• health status

• National Statistics Socio-economic Classification (NS-SEC)

• place of residence

Occupation was derived from Census 2021 and was classified according to our Standard Occupational Classification (SOC) 2020. Because this occupation information was collected in 2021, it is likely to be misclassified for a proportion of people, as they have left the labour work force or changed occupation since 2011.

The vaccination data covered the period 8 December 2020 to 2 March 2023. However, there may be an additional lag in data reporting such that it is possible we have not captured all vaccinations received by 2 March 2023.

Strengths

The linked dataset combines a rich set of demographic and socio-economic factors from the 2021 Census. This unique dataset allows us to analyse how rates of vaccination differ by socio-demographic group.

We used a population-level dataset for England, which enabled estimates of vaccine effectiveness to be calculated using a population representative of the general population of England.

Limitations

The dataset only contains information on people who were enumerated in the 2021 Census, and therefore excludes residents who did not take part.

The dataset used differs from that used by NHS England. As a result, the figures published will differ from those published by NHS England.