COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data

Abstract

ObjectiveTo investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.DesignPublicly available register-based ecological study.SettingTwo hundred and nine countries/territories in the world.ParticipantsAggregated data including 10 445 656 confirmed COVID-19 cases.Primary and secondary outcome measuresCOVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.ResultsThe average of country/territory-specific COVID-19 CFR is about 2%–3% worldwide and higher than previously reported at 0.7%–1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.ConclusionThe association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.

The Burden of COVID-19 Infection in a Rural Tamil Nadu Community

“…Only 3 (1.6%) out of the 182 fever clinic participants had died when we undertook telephone follow-up, and 16 (8.8%) had suffered a severe illness. This case fatality rate (CFR) is low in comparison with other international studies; 27 national data in India show CFRs among men of 2.9% and 3.3% among women. 28 It may indicate that, while the epidemic has taken hold in our rural population, its impact in terms of prolonged, severe illness and death, may be lower than in other, seemingly less vulnerable populations.…”

Macrolevel association of COVID-19 with non-communicable disease risk factors in India

“…Influence of demographic and socioeconomic factors in the COVID-19 case-fatality rate globally was examined among 10.5 million cases in 209 countries. Doubling in size of population, proportion of female smokers, higher stringency index and active testing policies were associated with higher case-fatality rate while inverse association was found between cardiovascular disease death rate and diabetes prevalence [ 36 ]. In the present study we did not find any association of case-fatality rates in different Indian states with NCD risk factors and other indices (data not shown) and therefore we have not commented on this issue.…”

Geospatial Analysis of COVID-19: A Scoping Review

“…Every country has been affected differently and has exhibited a unique pattern of incidence and mortality under the influence of many underlying factors. Temporal and spatial variation in the incidence rate of COVID-19 have produced the three distinctive high-rate clusters, initially China, then Western Europe, and finally the USA [ 2 , 3 ].…”