Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study

Pastor-Barriuso, Roberto; Pérez-Gómez, Beatriz; Hernán, Miguel A; Pérez-Olmeda, Mayte; Yotti, Raquel; Oteo-Iglesias, Jesús; Sanmartín, Jose L; León-Gómez, Inmaculada; Fernández-García, Aurora; Fernández-Navarro, Pablo; Cruz, Israel; Martín, Mariano; Delgado-Sanz, Concepción; Fernández de Larrea, Nerea; León Paniagua, Jose; Muñoz-Montalvo, Juan F; Blanco, Faustino; Larrauri, Amparo; Pollán, Marina; Aparicio Azcárraga, Pilar; Blanco, Faustino; Gutiérrez Fernández, Rodrigo; Martín, Mariano; Mezcua Navarro, Saturnino; Molina, Marta; Muñoz-Montalvo, Juan F; Salinero Hernández, Matías; Sanmartín, Jose L; Cuenca-Estrella, Manuel; León Paniagua, José; Yotti, Raquel; Delgado-Sanz, Concepción; Fernández de Larrea, Nerea; Fernández-Navarro, Pablo; Gómez-Barroso, Diana; Larrauri, Amparo; León-Gómez, Inmaculada; Pastor-Barriuso, Roberto; Pérez-Gómez, Beatriz; Pollán, Marina; Avellón, Ana; Fedele, Giovanni; Fernández-García, Aurora; Oteo Iglesias, Jesús; Pérez Olmeda, María Teresa; Cruz, Israel; Fernández Martínez, Maria Elena; Rodríguez-Cabrera, Francisco D; Hernán, Miguel A; Padrones Fernández, Susana; Rumbao Aguirre, José Manuel; Navarro Marí, José M; Palop Borrás, Begoña; Pérez Jiménez, Ana Belén; Rodríguez-Iglesias, Manuel; Calvo Gascón, Ana María; Lou Alcaine, María Luz; Donate Suárez, Ignacio; Suárez Álvarez, Oscar; Rodríguez Pérez, Mercedes; Cases Sanchís, Margarita; Villafáfila Gomila, Carlos Javier; Carbo Saladrigas, Lluis; Hurtado Fernández, Adoración; Oliver, Antonio; Castro Feliciano, Elías; González Quintana, María Noemí; Barrasa Fernández, José María; Hernández Betancor, María Araceli; Hernández Febles, Melisa; Martín Martín, Leopoldo; López López, Luis-Mariano; Ugarte Miota, Teresa; De Benito Población, Inés; Celada Pérez, María Sagrario; Vallés Fernández, María Natalia; Maté Enríquez, Tomás; Villa Arranz, Miguel; Domínguez-Gil González, Marta; Fernández-Natal, Isabel; Megías Lobón, Gregoria; Muñoz Bellido, Juan Luis; Ciruela, Pilar; Mas i Casals, Ariadna; Doladé Botías, Maria; Marcos Maeso, M Angeles; Pérez del Campo, Dúnia; Félix de Castro, Antonio; Limón Ramírez, Ramón; Elías Retamosa, Maria Francisca; Rubio González, Manuela; Blanco Lobeiras, María Sinda; Fuentes Losada, Alberto; Aguilera, Antonio; Bou, German; Caro, Yolanda; Marauri, Noemí; Soria Blanco, Luis Miguel; del Cura González, Isabel; Hernández Pascual, Montserrat; Alonso Fernández, Roberto; Merino-Amador, Paloma; Cabrera Castro, Natalia; Tomás Lizcano, Aurora; Ramírez Almagro, Cristóbal; Segovia Hernández, Manuel; Ascunce Elizaga, Nieves; Ederra Sanz, María; Ezpeleta Baquedano, Carmen; Bustinduy Bascaran, Ana; Iglesias Tamayo, Susana; Elorduy Otazua, Luis; Benarroch Benarroch, Rebeca; Lopera Flores, Jesús; Vázquez de la Villa, Antonia

OBJECTIVE: To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes. DESIGN: Nationwide seroepidemiological study. SETTING: First wave of covid-19 pandemic in Spain. PARTICIPANTS: Community dwelling individuals of all ages. MAIN OUTCOME MEASURES: The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020. RESULTS: The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more. CONCLUSION: The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.