COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data
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 65...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e043560.full |
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| author | Scott Montgomery Yang Cao Ayako Hiyoshi |
| author_facet | Scott Montgomery Yang Cao Ayako Hiyoshi |
| author_sort | Scott Montgomery |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-44e9ca3fe3eb44f89843695f374f1e31 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-44e9ca3fe3eb44f89843695f374f1e312024-11-26T14:00:09ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-043560COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level dataScott Montgomery0Yang Cao1Ayako Hiyoshi2Clinical Epidemiology and Biostatistics, Örebro Universitet—Campus USÖ, Orebro, SwedenUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, SwedenClinical Epidemiology and Biostatistics, Örebro Universitet—Campus USÖ, Orebro, SwedenObjective 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.https://bmjopen.bmj.com/content/10/11/e043560.full |
| spellingShingle | Scott Montgomery Yang Cao Ayako Hiyoshi COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data BMJ Open |
| title | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
| title_full | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
| title_fullStr | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
| title_full_unstemmed | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
| title_short | COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data |
| title_sort | covid 19 case fatality rate and demographic and socioeconomic influencers worldwide spatial regression analysis based on country level data |
| url | https://bmjopen.bmj.com/content/10/11/e043560.full |
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