[hannob]

I found the intro very confusing, tbh.

Particularly the "no increased risk of all-cause mortality". I mean, if we assume the vaccines worked, we'd certainly expect a decreased risk of all-case mortality (because "all-case mortality" certainly includes "covid mortality"). Reading "no increase" seems to imply "it doesn't change anything". Yeah, technically, the sentence does not say that ("no increase" can mean "no decrease" or "no change").

You have to read further below to get what should be the real message on all-cause-mortality: "Vaccinated individuals had [...] a 25% lower risk of all-cause mortality". I think that should've been in the first 1-2 sentences.

[eddieroger]

Frame it as the safety of the vaccine, not the efficacy of it. If it was about efficacy, it would lead with the 25% lower risk because of COVID safety. But, these days, there are people who think vaccines are dangerous just because, so saying that taking the vaccine or not has equal mortality puts that to rest (or at least does for those who find science real).

[zosima]

The reduction in all-cause mortality was independent of covid deaths.

Which seems to suggest that there was big differences between the groups other than the vaccination.

This of course does not change that the vaccine seems mostly safe, but it definitely calls in to question whether the protection against covid death was vaccine-mediated or due to some other difference between the groups.

Therefore this paper is moderately strong evidence for the vaccine being safe, but quite weak evidence for the vaccine being efficacious.

[a_cardboard_box]

Yes, but they incorrectly called it all-cause mortality under Findings. "Mortality" on it's own would be fine. "Mortality from other causes" would be better.

[groestl]

A common pattern you'd find in reliable research papers is that authors tend to understate their findings, which in practice strengthens the impact of their conclusions.

[simonster]

The problem is that 25% lower risk of all-cause mortality is too big to be explained solely by the vaccine. The reduction is similar when excluding deaths due to COVID-19, and is probably driven by people who got the vaccine being different in some ways that the observational study isn’t controlling for.

[hannob]

Yeah, but there's a plausible explanation for this: Likely, people who get vaccinated also are more likely to do other things to improve their health.

[bluGill]

If you don't get the covid vaccine you probably do other risky things. Not get other vaccines, don't see the doctor about various issues...

[TheBigSalad]

Could it mean that lots of Covid deaths are being attributed to other things?

[bloqs]

Not getting the vaccine is statisically correlated with distrust in traditional medicine, and suceptibility to giving undue attention and credit to unfounded and unsound practices.

[btilly]

This is a general problem in many technical fields.

People in a technical field, learn to "chunk" complex phrases. Their natural communication style becomes complex. Which makes them hard to understand to those outside of the field. If they want to be understood, the solution isn't to try to educate the world. It is to educate themselves. To learn how to write simply and directly.

Depending on the readability test used, the section up to "Introduction" - which is supposed to be readable - is somewhere between advanced high school and university. See https://www.online-utility.org/english/readability_test_and_... or other free tools to test it. That's bad. The percentage of Americans who can read this text is below the percentage who could read, say, a plain language version written in Spanish. We should expect people to misunderstand. We should not expect this paper to convince.

[acjohnson55]

Papers like this are designed to fit into the conventions that allow knowledge to compound. Not that the conventions are perfect at doing this.

I would suggest that rather than changing this convention in a big way, there needs to be good pathways for communicating the most important takeaways to the general public. Unfortunately, there's kind of a chasm between academia and popular science.

[ceejayoz]

Eh, it's an important point. "It made COVID things much better, and it didn't make other unrelated things worse."

[hervature]

Looking at Table 2 and as the name suggests, COVID is included in "all-cause" mortality. Your statement does not follow because it could have made COVID outcomes better yet "all-other" causes worse for a neutral "no increase in all-cause". If you look at Table 2, you can see that the vaccinated group is less mortality in all diseases. That being said, as much as I think this is over-stated, this is very much a correlation thing because we all know that unvaccinated individuals live their lives differently compared to vaccinated individuals. Even accounting for similar statistics, the one group is prone to higher death rates not because they are unvaccinated but because of the reason they are unvaccinated.

[purpleflame1257]

It's interesting that they leave things at 18-59. Do they later stratify into 18-28, 29-38, 39-48, 48-58?

[ceejayoz]

Looks like they do, yes.

> A stronger association was observed among individuals aged 18 to 29 years, although the underlying reasons remain unclear and warrant further investigation.

[amluto]

> "no increased risk of all-cause mortality"

My take is not quite as charitable as most of the comments, although my objection only barely applies to this particular paper. Biomedical research has long tradition of a very specific type of analysis: hypothesis testing. Roughly speaking, you make a hypothesis and test your data for compatibility with the hypothesis. In this paper, the authors are comparing two hypotheses: (a) there is an increased risk of all-cause mortality or (b) the increase in risk is zero or negative [0]. And the statement you’re quoting from the conclusion section sure sounds like it’s saying that the authors found that the data was consistent with (b) but not with (a).

Researchers love this. There are lots of papers with fancy-named tests with which one can do this analysis. Regulators often demand it.

And it produces papers that are correct in a fairly literal sense but miss the point entirely. For example, “we found no evidence that vaccines increase the risk of autism”. I, too, can look under my bed or study four people and find no evidence of anything at all about vaccines and autism, and I would be more or less justified in making that claim.

And because of this, you need to read papers very carefully to see what you can actually conclude. “No evidence” means a lot more in a large (“high powered”) study than in a small, weak study.

The right way to do this is something like “we looked at such-and-such data and found, with 95% confidence, that the increase in risk of X is <= 0.2%” or even that “the change in risk is <= -25%” (check out that minus sign!). If I look under my bed, I will find evidence that the increased absolute of autism caused by vaccines is <= 100%, and I didn’t need to study anything to confirm that :)

Fortunately, this particular paper has the silly throwaway starting you’re complaining about in a few places but is otherwise mostly on the right track. Quoting from the Results section:

> Vaccinated individuals had a 74% lower risk of death from severe COVID-19 (weighted hazard ratio [wHR], 0.26 [95% CI, 0.22-0.30]) and a 25% lower risk of all-cause mortality (wHR, 0.75 [95% CI, 0.75-0.76]), with a similar association observed when excluding severe COVID-19 death. Sensitivity analysis revealed that vaccinated individuals consistently had a lower risk of death, regardless of the cause.

IMO that should have been the headline. The latter sentence there is giving some indication that the result is robust and that the researchers didn’t flub it or get unlucky in quality of their data.

P.S. The fact that the vaccines seemed to reduce the risk is death from causes other than severe covid is interesting. I wonder how much is reducing death from complications of COVID other than “severe covid”, how much is behavioral changes (vaccinated whole socializing more and leaving their houses more), and how much is bizarre off-target effects of the mRNA vaccines. Here’s an example of a surprising off-target benefit that no one understands well:

https://www.science.org/content/blog-post/mrna-vaccines-and-...

[0] I think. I didn’t reread it enough times to rule out the other common test: is the data consistent with the hypothesis that the risk didn’t change at all, which is also sadly common. But I’m moderately sure I’m right in the context of this paper.

[exceptthisthing]

Because this whole paper is bullshit and is a bias confirmation report

It assesses persons "who were alive on November 1, 2021"

That tantamount to saying "for people alive January 1st 1950, the Second World War was not a significant cause of mortality"

Can you see how ridiculous that sounds?

[biophysboy]

No, because the same conditional is applied to both participant groups. Its good to specify a time frame.

[hervature]

While you are being downvoted, this is actually an astute observation. However, your point is working against you in this case. If the vaccine was actually deadly, the unvaccinated individuals who survived the pandemic would be having better health outcomes. This is not what they found. If they included the pandemic in this study, the deaths by COVID would be much worse in the unvaccinated group.

[dwroberts]

> That tantamount to saying "for people alive January 1st 1950, the Second World War was not a significant cause of mortality"

That’s a nonsense comparison because the thing they are studying is the vaccine, not COVID itself. The vaccine was available at minimum, what, end of 2020? Exposure being defined as first dose May-October 2021 does not seem unreasonable at all (and probably not arbitrarily chosen right - it’s probably something to do with the availability of data)

[gus_massa]

It's a good observation, but I expect that even considering only people alive in 1950, survivors of the Hiroshima bombing or concentration camps (or a few other events), still have long term problems that increase mortality.

[SketchySeaBeast]

I honestly wonder if it's better to flag and downvote into oblivion rather than to engage in good faith. The sibling didn't seem like they were trolling, just misguided, and shutting down discussion doesn't allow for any reflection.

I suppose the problem is that it was unlikely to be productive.