Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications

Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were pu...

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Bibliographic Details
Published in:European journal of epidemiology Vol. 35; no. 12; pp. 1123 - 1138
Main Authors: Levin, Andrew T., Hanage, William P., Owusu-Boaitey, Nana, Cochran, Kensington B., Walsh, Seamus P., Meyerowitz-Katz, Gideon
Format: Journal Article
Language:English
Published: Dordrecht Springer Netherlands 01.12.2020
Springer Nature B.V
Subjects:
Adult
Adults
Age
Age composition
Aged
Aged, 80 and over
Cardiology
Cause of Death
Coronaviruses
COVID-19
COVID-19 - mortality
COVID-19 - virology
Epidemiology
Fatalities
Female
Geographical locations
Health policy
Humans
Infections
Infectious Diseases
Influenza
Male
Medicine
Medicine & Public Health
Meta-Analysis
Middle Aged
Models, Statistical
Mortality
Older people
Oncology
Pandemics - statistics & numerical data
Predictive Value of Tests
Public Health
Public Policy
Regression analysis
SARS-CoV-2
Severity of Illness Index
Systematic review
Traffic accidents
Viral diseases
Young Adult
COVID-19
Infection-fatality rate
Meta-regression
Systematic review
SARS-CoV-2
Infection-fatality ratio
ISSN:0393-2990, 1573-7284, 1573-7284
Online Access:Get full text
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Summary:Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.
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ISSN:0393-2990
1573-7284
1573-7284
DOI:10.1007/s10654-020-00698-1