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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| Veröffentlicht in: | BMJ open Jg. 10; H. 11; S. e043560 |
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| Hauptverfasser: | , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
British Medical Journal Publishing Group
03.11.2020
BMJ Publishing Group LTD BMJ Publishing Group |
| Schriftenreihe: | Original research |
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| ISSN: | 2044-6055, 2044-6055 |
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| 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. |
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| AbstractList | To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.OBJECTIVETo investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.Publicly available register-based ecological study.DESIGNPublicly available register-based ecological study.Two hundred and nine countries/territories in the world.SETTINGTwo hundred and nine countries/territories in the world.Aggregated data including 10 445 656 confirmed COVID-19 cases.PARTICIPANTSAggregated data including 10 445 656 confirmed COVID-19 cases.COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.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.The 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.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.The 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.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. OBJECTIVE: To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. DESIGN: Publicly available register-based ecological study. SETTING: Two hundred and nine countries/territories in the world. PARTICIPANTS: Aggregated data including 10 445 656 confirmed COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website. RESULTS: The 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. CONCLUSION: The 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. To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. Publicly available register-based ecological study. Two hundred and nine countries/territories in the world. Aggregated data including 10 445 656 confirmed COVID-19 cases. COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website. The 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. The 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. 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. Objective To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.Design Publicly available register-based ecological study.Setting Two hundred and nine countries/territories in the world.Participants Aggregated data including 10 445 656 confirmed COVID-19 cases.Primary and secondary outcome measures COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.Results The 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.Conclusion The 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. |
| Author | Cao, Yang Hiyoshi, Ayako Montgomery, Scott |
| AuthorAffiliation | 1 Clinical Epidemiology and Biostatistics, Universitetssjukhuset Örebro, School of Medical Sciences , Örebro University , Örebro , Sweden 2 Unit of Integrative Epidemiology, Institute of Environmental Medicine , Karolinska Institutet , Stockholm , Sweden 3 Department of Public Health Sciences , Stockholm University , Stockholm , Sweden 4 Clinical Epidemiology Division, Department of Medicine , Karolinska Institutet , Stockholm , Sweden 5 Department of Epidemiology and Public Health , University College London , London , United Kingdom |
| AuthorAffiliation_xml | – name: 2 Unit of Integrative Epidemiology, Institute of Environmental Medicine , Karolinska Institutet , Stockholm , Sweden – name: 4 Clinical Epidemiology Division, Department of Medicine , Karolinska Institutet , Stockholm , Sweden – name: 5 Department of Epidemiology and Public Health , University College London , London , United Kingdom – name: 1 Clinical Epidemiology and Biostatistics, Universitetssjukhuset Örebro, School of Medical Sciences , Örebro University , Örebro , Sweden – name: 3 Department of Public Health Sciences , Stockholm University , Stockholm , Sweden |
| Author_xml | – sequence: 1 givenname: Yang orcidid: 0000-0002-3552-9153 surname: Cao fullname: Cao, Yang email: yang.cao@oru.se organization: Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden – sequence: 2 givenname: Ayako surname: Hiyoshi fullname: Hiyoshi, Ayako organization: Department of Public Health Sciences, Stockholm University, Stockholm, Sweden – sequence: 3 givenname: Scott orcidid: 0000-0001-6328-5494 surname: Montgomery fullname: Montgomery, Scott organization: Department of Epidemiology and Public Health, University College London, London, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33148769$$D View this record in MEDLINE/PubMed https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-87238$$DView record from Swedish Publication Index (Örebro universitet) https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-189272$$DView record from Swedish Publication Index (Stockholms universitet) http://kipublications.ki.se/Default.aspx?queryparsed=id:145205414$$DView record from Swedish Publication Index (Karolinska Institutet) |
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724 2020110400201922000_10.11.e043560.60 2020110400201922000_10.11.e043560.64 Gallus (2020110400201922000_10.11.e043560.58) 2020 2020110400201922000_10.11.e043560.3 2020110400201922000_10.11.e043560.24 2020110400201922000_10.11.e043560.4 2020110400201922000_10.11.e043560.23 2020110400201922000_10.11.e043560.67 2020110400201922000_10.11.e043560.1 2020110400201922000_10.11.e043560.66 2020110400201922000_10.11.e043560.21 2020110400201922000_10.11.e043560.65 2020110400201922000_10.11.e043560.16 2020110400201922000_10.11.e043560.15 2020110400201922000_10.11.e043560.59 Li (2020110400201922000_10.11.e043560.68) 2020; 146 2020110400201922000_10.11.e043560.18 Henderson (2020110400201922000_10.11.e043560.2) 2020; 72 Zulu (2020110400201922000_10.11.e043560.13) 2014; 14 Cheng (2020110400201922000_10.11.e043560.63) 2020; 119 2020110400201922000_10.11.e043560.52 2020110400201922000_10.11.e043560.51 2020110400201922000_10.11.e043560.50 2020110400201922000_10.11.e043560.57 2020110400201922000_10.11.e043560.12 2020110400201922000_10.11.e043560.56 2020110400201922000_10.11.e043560.11 2020110400201922000_10.11.e043560.54 Stevens (2020110400201922000_10.11.e043560.48) 2016; 13 2020110400201922000_10.11.e043560.49 2020110400201922000_10.11.e043560.47 Ogen (2020110400201922000_10.11.e043560.29) 2020; 726 Ren (2020110400201922000_10.11.e043560.40) 2014; 41 Khlat (2020110400201922000_10.11.e043560.55) 2016; 13 Cai (2020110400201922000_10.11.e043560.53) 2020; 8 Ahmadi (2020110400201922000_10.11.e043560.62) 2020; 729 (2020110400201922000_10.11.e043560.69) 2020; 69 2020110400201922000_10.11.e043560.82 2020110400201922000_10.11.e043560.81 Klang (2020110400201922000_10.11.e043560.22) 2020; 28 2020110400201922000_10.11.e043560.80 2020110400201922000_10.11.e043560.42 2020110400201922000_10.11.e043560.41 Garnier-Crussard (2020110400201922000_10.11.e043560.75) 2020; 68 2020110400201922000_10.11.e043560.83 2020110400201922000_10.11.e043560.46 2020110400201922000_10.11.e043560.45 2020110400201922000_10.11.e043560.44 Onder (2020110400201922000_10.11.e043560.8) 2020; 323 2020110400201922000_10.11.e043560.43 2020110400201922000_10.11.e043560.39 2020110400201922000_10.11.e043560.38 2020110400201922000_10.11.e043560.37 2020110400201922000_10.11.e043560.36 Russell (2020110400201922000_10.11.e043560.10) 2020; 25 Sasaki (2020110400201922000_10.11.e043560.17) 2008; 79 Wu (2020110400201922000_10.11.e043560.28) 2020 Mizumoto (2020110400201922000_10.11.e043560.79) 2020; 25 2020110400201922000_10.11.e043560.71 2020110400201922000_10.11.e043560.70 2020110400201922000_10.11.e043560.31 2020110400201922000_10.11.e043560.74 2020110400201922000_10.11.e043560.73 2020110400201922000_10.11.e043560.72 2020110400201922000_10.11.e043560.35 Rajgor (2020110400201922000_10.11.e043560.9) 2020; 20 2020110400201922000_10.11.e043560.34 2020110400201922000_10.11.e043560.78 2020110400201922000_10.11.e043560.33 2020110400201922000_10.11.e043560.77 2020110400201922000_10.11.e043560.32 2020110400201922000_10.11.e043560.76 Brooke (2020110400201922000_10.11.e043560.19) 2020; 29 2020110400201922000_10.11.e043560.27 2020110400201922000_10.11.e043560.26 2020110400201922000_10.11.e043560.25 Sjödin (2020110400201922000_10.11.e043560.61) 2020; 25 |
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| Snippet | ObjectiveTo investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.DesignPublicly available... To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. Publicly available register-based... To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.OBJECTIVETo investigate the influence... OBJECTIVE: To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. DESIGN: Publicly available... Objective To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally. Design Publicly available... Objective To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.Design Publicly available... |
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| SubjectTerms | 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 |
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| Title | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
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