Preprint Article Version 1 This version is not peer-reviewed

Why Has COVID-19 Mortality Been Higher in Certain Countries Than Others? An Ecological Analysis of 204 Countries

Version 1 : Received: 20 June 2020 / Approved: 21 June 2020 / Online: 21 June 2020 (10:01:26 CEST)

How to cite: Kenyon, C. Why Has COVID-19 Mortality Been Higher in Certain Countries Than Others? An Ecological Analysis of 204 Countries. Preprints 2020, 2020060246 (doi: 10.20944/preprints202006.0246.v1). Kenyon, C. Why Has COVID-19 Mortality Been Higher in Certain Countries Than Others? An Ecological Analysis of 204 Countries. Preprints 2020, 2020060246 (doi: 10.20944/preprints202006.0246.v1).

Abstract

Background: It is unclear why certain countries have been more severely affected by COVID-19 than other countries. Methods: In this ecological study we compared COVID-19 mortality and incidence/100,000 as well as 4 putative explanatory factors by WHO world region. Linear regression was then used to assess the country-level predictors of COVID-19 mortality/100,000 and incidence/100,000 in 204 countries with available data. Results: COVID-19 incidence and mortality/capita were greater in Europe than other regions. This was despite a higher testing rate in Europe than other regions. Europe had an older population than all other regions and a higher prevalence of obesity than Africa, South East Asia and the Eastern Mediterranean. Country level multiple linear regression revealed positive associations between mortality/capita and testing rate, percent of the population 65 years or older, and Europe compared to Western Pacific and South East Asia (all P<0.005). Results for the analyses with cases/100,000 as outcome variable were similar. Conclusion: Our results suggest that older populations as well as other undefined regional and national factors, possibly related to efficacy of control efforts, are responsible for differences in national severity COVID-19 epidemics.

Subject Areas

SARS-CoV-2; COVID-19 mortality rate; testing intensity; epidemiology; Europe; Asia; obesity; elderly

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