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

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 co...

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Published in:BMJ open Vol. 10; no. 11; p. e043560
Main Authors: Cao, Yang, Hiyoshi, Ayako, Montgomery, Scott
Format: Journal Article
Language:English
Published: England British Medical Journal Publishing Group 03.11.2020
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Original research
Subjects:
Age Distribution
Betacoronavirus
Cardiovascular Diseases - mortality
Clinical Laboratory Techniques - statistics & numerical data
Communicable Disease Control - statistics & numerical data
Coronavirus Infections - diagnosis
Coronavirus Infections - mortality
Coronaviruses
COVID-19
COVID-19 Testing
Datasets
Diabetes
Diabetes Mellitus - epidemiology
Disease prevention
Epidemiology
Estimates
Fatalities
Gross Domestic Product - statistics & numerical data
Health Policy
Health Status Indicators
Humans
Life Expectancy
Mortality
Pandemics
Pneumonia, Viral - mortality
Population
Population Density
Prevalence
Public health
Regression analysis
Risk factors
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Smoking - epidemiology
Socioeconomic factors
Spatial Analysis
Spatial Regression
Variables
China
COVID-19
epidemiology
public health
ISSN:2044-6055, 2044-6055
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Summary: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.
Bibliography:Original research
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2020-043560