Work

Twelve-month all-cause mortality after initial COVID-19 vaccination with Pfizer-BioNTech or mRNA-1273 among adults living in Florida: Statewide cohort study

Year: 2026

Type: article

Abstract: Background Comparative effects of the mRNA COVID-19 vaccines on health outcomes are uncertain. The study objective was to compare all-cause and non-COVID-19 mortality between recipients of BNT162b2 (Pfizer) and mRNA-1273 (Moderna). Methods Matched cohort analysis of 1,962,822 adults living in Florida who received a first dose of either BNT162b2 or mRNA-1273 between December 18, 2020, and August 31, 2021, was used to examine 12-month risk of all-cause, cardiovascular, COVID-19, and non-COVID-19 mortality. Matching was performed on seven criteria, including age group, sex, race, ethnicity, calendar month of vaccination, nine types of vaccination sites, and 4832 census tracts. Kaplan-Meir estimators and Cox proportional hazards regressions were used. Results Compared with mRNA-1273 recipients, BNT162b2 recipients had higher hazard of all-cause mortality (784 vs. 562 deaths per 100,000; hazard ratio, HR [95% CI]: 1.40 [1.36, 1.45]), cardiovascular mortality (226 vs. 145 deaths per 100,000 persons; HR [95% CI]: 1.57 [1.47, 1.68]), COVID-19 mortality (61 vs. 32 deaths per 100,000 persons; HR [95% CI]: 1.91 [1.67, 2.19]) and non-COVID-19 mortality (722 vs. 530 deaths per 100,000 persons; HR [95% CI]: 1.37 [1.32, 1.42]). Negative control outcomes and robustness analyses did not show any indication of meaningful unobserved residual confounding likely to alter the results, although there was evidence of potential small residual imbalance among adults 60 years and older. Conclusion Florida adults who received the BNT162b2 COVID-19 vaccine in the initial series had higher risk of 12-month all-cause, cardiovascular, COVID-19, and non-COVID-19 mortality compared to matched mRNA-1273 recipients, with differences in cardiovascular and COVID-19 mortality primarily driven by adults 60 and older. These findings suggest that COVID-19- and non-COVID-19-related health outcomes should be considered when evaluating vaccines targeting SARS-CoV-2. Primary Funding Source: The study did not receive any external funding.

Source: Global Epidemiology

DOI: 10.1016/j.gloepi.2026.100296

Authors: Retsef Levi, Fahad Mansuri, Melissa M. Jordan, Joseph A. Ladapo

Institutions: Massachusetts Institute of Technology, Florida Department of Health

Language: English

Topic: SARS-CoV-2 and COVID-19 Research

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,670