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Case fatality rate of COVID-19: a systematic review and meta-analysis
Yousef Alimohamadi1,2, Habteyes Hailu Tola3, Abbas Abbasi-Ghahramanloo4
1Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran.
Insights
This systematic review found the overall COVID-19 case fatality rate (CFR) to be 10.0%. The CFR varied significantly by patient group, with higher rates in hospitalized and ICU patients, and those over 50 years old.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- The novel coronavirus disease 2019 (COVID-19) emerged as a significant global health threat, causing widespread morbidity and mortality.
- Existing primary studies reported highly variable case fatality rates (CFR) for COVID-19, necessitating a consolidated estimate.
- There was a lack of comprehensive review studies to accurately assess the pooled CFR of COVID-19.
Purpose of the Study:
- To systematically review and meta-analyze existing data to estimate the pooled case fatality rate (CFR) of COVID-19.
- To provide a more accurate and reliable CFR estimate for COVID-19 by synthesizing findings from multiple primary studies.
Main Methods:
- A systematic search of electronic databases including PubMed, Science Direct, Scopus, and Google Scholar was conducted.
- Keywords related to COVID-19 and case fatality rate were used for study retrieval.
- A random-effects model was employed to estimate the pooled CFR, with heterogeneity assessed using I² statistics, Cochran's Q test, and T².
Main Results:
- The overall pooled CFR for COVID-19 was estimated at 10.0% (95% CI: 8.0-11.0).
- Subgroup analysis revealed a CFR of 1.0% in the general population, 13.0% in hospitalized patients, 37.0% in intensive care unit (ICU) patients, and 19.0% in patients older than 50 years.
- Significant heterogeneity was observed across the included studies (I² > 94% for all estimates).
Conclusions:
- The findings underscore the critical need for standardized reporting of testing and case definitions in CFR estimations.
- Transparency regarding patient demographics, including age, sex, and comorbidity distribution, is essential for accurate CFR comparisons across different populations.
- The study highlights the importance of robust data collection and reporting for understanding disease severity and informing public health strategies.
Objective:
The ongoing novel coronavirus disease 2019 (COVID-19) is the leading cause of morbidity and mortality due to its contagious nature and absence of vaccine and treatment. Although numerous primary studies reported extremely variable case fatality rate (CFR) of COVID-19, no review study attempted to estimate the CFR of COVID-19. The current systematic review and meta-analysis were aimed to assess the pooled CFR of COVID-19.
Methods:
Electronic databases: PubMed, Science Direct, Scopus, and Google Scholar were searched to retrieve the eligible primary studies that reported CFR of COVID-19. Keywords: ("COVID-19"OR "COVID-2019" OR "severe acute respiratory syndrome coronavirus 2"OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2" OR "2019nCoV" OR (("Wuhan" AND ("coronavirus" OR "coronavirus")) AND (2019/12[PDAT] OR 2020[PDAT]))) AND ("mortality "OR "mortality" OR ("case" AND "fatality" AND "rate") OR "case fatality rate") were used as free text and MeSH term in searching process. A random-effects model was used to estimate the CFR in this study. I2 statistics, Cochran's Q test, and T2 were used to assess the functional heterogeneity between included studies.
Results:
The overall pooled CFR of COVID 19 was 10.0%(95% CI: 8.0-11.0); P < 0.001; I2 = 99.7). The pooled CFR of COVID-19 in general population was 1.0% (95% CI: 1.0-3.0); P < 0.001; I2 = 94.3), while in hospitalized patients was 13.0% (95% CI: 9.0-17.0); P < 0.001, I2 = 95.6). The pooled CFR in patients admitted in intensive care unit (ICU) was 37.0% (95% CI: 24.0-51.0); P < 0.001, I2 = 97.8) and in patients older than 50 years was 19.0% (95% CI: 13.0-24.0); P < 0.001; I2 = 99.8).
Conclusion:
The present review results highlighted the need for transparency in testing and reporting policies and denominators used in CFR estimation. It is also necessary to report the case's age, sex, and the comorbidity distribution of all patients, which essential in comparing the CFR among different segments of the population.
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