As part of the strengthened surveillance system for COVID-19 vaccines, pharmaco-epidemiological surveillance is being implemented by EPI-PHARE to quantify the risk of serious post-vaccine adverse events, including deaths and hospitalizations.

Deaths and hospitalizations occur daily, regardless of vaccination, especially in the elderly population. Therefore, it is important to estimate the expected frequency of these events outside the context of the COVID-19 vaccination campaign, in order to have objective figures to compare with those that will be reported in the context of monitoring the health status of vaccinated persons, and thus be able to correctly interpret these data.

In a previous report, based on the figures observed among people in residential establishments for dependent elderly people (EHPAD) or long-term care units (USLD) in 2018 and 2019, we estimated that during the first three months of 2021 the expected number of deaths and hospitalizations among the residents of these facilities was in the order of 465 deaths and more than 1000 hospitalizations per day.

Since vaccination now concerns all persons aged 75 years and over and will soon concern persons aged 65 years and over, it is important to estimate the expected frequency of these events also for persons in these age groups, the vast majority of whom are not institutionalized.

The objective of this new study was to describe the frequency of deaths and hospitalizations in 2018 and 2019 among non-institutionalized persons aged 65 and over residing in France, using data from INSEE and the National Health Data System (SNDS).

In 2018-2019, the French population included 5.8 million non-institutionalized persons aged 75 and over. Of these, 20,000 to 27,000 (3.5 to 5‰) died each month (an average of 650 to 880 per day) and 250,000 to 350,000 (45 to 60‰) were hospitalized (10,000 to 11,000 per day) depending on the time of year. Among the 7 million non-institutionalized people aged 65 to 74, these figures were 7,000 to 8,000 deaths (1‰) and 200,000 to 300,000 hospitalizations (30 at 45‰) per month (i.e. 220 to 260 deaths and 9,000 to 10,000 hospitalizations per day).

Although these figures should be interpreted with caution, they may provide an initial basis for comparison in monitoring vaccine safety in this population, pending the implementation of fine pharmaco-epidemiology studies by EPI-PHARE as part of the reinforced surveillance of vaccines against COVID-19; these studies will make it possible, using a comparative population-based approach, to measure the risks of serious post-vaccine adverse events at the level of the entire population in France.