National case fatality rates of the COVID-19 pandemic

Ergönül, Önder; Akyol, Merve; Tanrıöver, Cem; Tiemeier, Henning; Petersen, Eskild; Petrosillo, Nicola; Gönen, Mehmet

OBJECTIVES: The case fatality rate (CFR) of Coronavirus disease 2019 (COVID-19) varies significantly between countries. We aimed to describe the associations of health indicators with the national CFRs of COVID-19. METHODS: We identified health indicators for each country 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 Co-operation 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 percent 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), 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 the 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.