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. 2022 May;175(5):634-643.
doi: 10.7326/M21-3023. Epub 2022 Mar 22.

Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World Data

Chengyi Zheng  1 , Jonathan Duffy  2 , In-Lu Amy Liu  1 , Lina S Sy  1 , Wansu Chen  1 , Lei Qian  1 , Ronald A Navarro  3 , Denison S Ryan  1 , Sunhea S Kim  1 , Cheryl Mercado  1 , Steven J Jacobsen  1
Affiliations

Risk for Shoulder Conditions After Vaccination: A Population-Based Study Using Real-World Data

Chengyi Zheng et al. Ann Intern Med. 2022 May.

Abstract

Background: Although shoulder conditions have been reported as an adverse event after intramuscular vaccination in the deltoid muscle, epidemiologic data on shoulder conditions after vaccination are limited.

Objective: To estimate the risk for shoulder conditions after vaccination and assess possible risk factors.

Design: Retrospective cohort study.

Setting: Kaiser Permanente Southern California, a large integrated health care organization.

Participants: Kaiser Permanente Southern California members aged 3 years or older who had an intramuscular vaccination administered in the deltoid muscle between 1 April 2016 and 31 December 2017.

Measurements: A natural language processing (NLP) algorithm was used to identify potential shoulder conditions among vaccinated persons with shoulder disorder diagnosis codes. All NLP-identified cases were manually chart confirmed on the basis of our case definition. The characteristics of vaccinated persons with and without shoulder conditions were compared.

Results: Among 3 758 764 administered vaccinations, 371 cases of shoulder condition were identified, with an estimated incidence of 0.99 (95% CI, 0.89 to 1.09) per 10 000 vaccinations. The incidence was 1.22 (CI, 1.10 to 1.35) for the adult (aged ≥18 years) and 0.05 (CI, 0.02 to 0.14) for the pediatric (aged 3 to 17 years) vaccinated populations. In the adult vaccinated population, advanced age, female sex, an increased number of outpatient visits in the 6 months before vaccination, lower Charlson Comorbidity Index, and pneumococcal conjugate vaccine were associated with a higher risk for shoulder conditions. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk for shoulder conditions. Simultaneous administration of vaccines was associated with a higher risk for shoulder conditions among elderly persons.

Limitation: Generalizability to other health care settings, use of administrative data, and residual confounding.

Conclusion: These population-based data suggest a small absolute risk for shoulder conditions after vaccination. Given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risks.

Primary funding source: Centers for Disease Control and Prevention.

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Figures

Figure 1.
Figure 1.
Flow diagram showing cohort eligibility, case finding by the NLP algorithm, and case confirmation. The index date is the vaccination date. ICD-10-CM= International Classification of Diseases, 10th Revision, Clinical Modification; NLP= natural language processing.
Figure 2.
Figure 2.
Adjusted ORs for shoulder conditions and associated risk factors among adults at the time of vaccination (n = 3006733). The final model included age, sex, Charlson Comorbidity Index, number of outpatient visits within the 6 mo before the index vaccination, PCV13, type of influenza vaccine, simultaneous vaccination, and the interaction between age and simultaneous vaccination. aIIV3= adjuvanted inactivated influenza vaccine trivalent; ccIIV4 = cell culture–based inactivated influenza vaccine quadrivalent; HD-IIV3= high-dose inactivated influenza vaccine trivalent; OR = odds ratio; PCV13= pneumococcal conjugate vaccine; SD-IIV3= standard-dose inactivated influenza vaccine trivalent; SD-IIV4= standard-dose inactivated influenza vaccine quadrivalent. * Values are statistically significant (P < 0.05).
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