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National case fatality rates of the COVID-19 pandemic
Önder Ergönül1, Merve Akyol2, Cem Tanrıöver2
1Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey; Koç University Research Centre for Infectious Diseases, Istanbul, Turkey; ESCMID Emerging Infections Task Force, ESCMID, Basel, Switzerland.
Insights
Higher obesity rates, tuberculosis incidence, and longer pandemic duration correlate with increased COVID-19 case fatality rates. Conversely, increased testing, hospital beds, and rural populations are linked to lower fatality rates.
Area of Science:
- Public Health
- Epidemiology
- Health Policy
Background:
- The case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) exhibits significant international variation.
- Understanding factors influencing national COVID-19 CFRs is crucial for effective public health interventions.
Purpose of the Study:
- To investigate the associations between various national health indicators and the COVID-19 CFR.
- To identify key demographic and healthcare system factors impacting COVID-19 mortality rates across OECD countries.
Main Methods:
- A multivariable analysis was conducted on 16 health indicators from international administrative data for 34 OECD countries.
- A dynamic web-based model was utilized to analyze and visualize the associations between health indicators and COVID-19 CFRs.
- The study adhered to the Guideline for Accurate and Transparent Health Estimates Reporting (GATHER).
Main Results:
- Factors significantly associated with increased COVID-19 CFR included: obesity prevalence in adults, tuberculosis incidence, duration since the first COVID-19 death, and median population age.
- Conversely, higher COVID-19 testing rates, greater hospital bed density, and a higher rural population ratio were associated with decreased CFRs.
Conclusions:
- The findings suggest that population density, healthcare capacity (hospital beds), and testing infrastructure are critical in mitigating COVID-19 mortality.
- Public health strategies should focus on protecting vulnerable populations, such as older adults and those with obesity, and enhancing diagnostic and treatment capacities.
Objectives:
The case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) varies significantly between countries. We aimed to describe the associations between health indicators and the national CFRs of COVID-19.
Methods:
We identified for each country health indicators potentially associated with the national CFRs of COVID-19. We extracted data for 18 variables from international administrative data sources for 34 member countries of the Organization for Economic Cooperation and Development (OECD). We excluded the collinear variables and examined the 16 variables in multivariable analysis. A dynamic web-based model was developed to analyse and display the associations for the CFRs of COVID-19. We followed the Guideline for Accurate and Transparent Health Estimates Reporting (GATHER).
Results:
In multivariable analysis, the variables significantly associated with the increased CFRs were percentage of obesity in ages >18 years (β = 3.26; 95%CI = 1.20, 5.33; p 0.003), tuberculosis incidence (β = 3.15; 95%CI = 1.09, 5.22; p 0.004), duration (days) since first death due to COVID-19 (β = 2.89; 95%CI = 0.83, 4.96; p 0.008), and median age (β = 2.83; 95%CI = 0.76, 4.89; p 0.009). The COVID-19 test rate (β = -3.54; 95%CI = -5.60, -1.47; p 0.002), hospital bed density (β = -2.47; 95%CI = -4.54, -0.41; p 0.021), and rural population ratio (β = -2.19; 95%CI = -4.25, -0.13; p 0.039) decreased the CFR.
Conclusions:
The pandemic hits population-dense cities. Available hospital beds should be increased. Test capacity should be increased to enable more effective diagnostic tests. Older patients and patients with obesity and their caregivers should be warned about a potentially increased risk.
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