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COVID-19 case-fatality rate and demographic and socioeconomic influencers: a worldwide spatial regression analysis based on country-level data

By Yang Cao, Ayako Hiyoshi, Scott Montgomery

Posted 31 Jul 2020
medRxiv DOI: 10.1101/2020.07.31.20165811

We used the COVID-19 dataset obtained from the Our World in Data website and investigated the associations between COVID-19 CFR and nine country-level indices of 209 countries/territories using the Matern correlation regression model. Spatial dependence among the data was controlled using the latitude and longitude of the centroid of the countries/territories. Stratified analyses were conducted by economic level and COVID-19 testing policy. The average of country/territory-specific COVID-19 CFR is about 2-3% worldwide, which is higher than previously reported at 0.7-1.3%. Statistically significant associations were observed between COVID-19 CFR and population size and proportion of female smokers. The open testing policies are associated with decreased CFR. 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. The statistically significant association between population size and COVID-19 CRF suggests the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in females and COVID-19 CFR might be due to that the proportion of female smokers reflected broadly 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.

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