Clinical Epidemiology and Biostatistics, Universitetssjukhuset Örebro, School of Medical Sciences, Örebro University, Örebro, Sweden
Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2020 Nov 3;10(11):e043560. doi: 10.1136/bmjopen-2020-043560.
To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.
Publicly available register-based ecological study.
Two hundred and nine countries/territories in the world.
Aggregated data including 10 445 656 confirmed COVID-19 cases.
COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.
The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The 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 (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.
The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the 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. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.
探讨人口统计学和社会经济学因素对全球 COVID-19 病死率（CFR）的影响。
公开可得的基于登记的生态研究。
世界上 209 个国家/地区。
使用 Our World in Data 网站上的国家/地区级别的数据，汇总了包括 10445656 例确诊 COVID-19 病例的聚合数据。
使用国家/地区数据计算 COVID-19 CFR 和粗死因特异性死亡率。
全球范围内，国家/地区特定 COVID-19 CFR 的平均值约为 2%-3%，高于之前报道的 0.7%-1.3%。人口规模翻倍与 COVID-19 CFR 增加 0.48%（95%置信区间 0.25%至 0.70%）相关，女性吸烟者比例翻倍与 COVID-19 CFR 增加 0.55%（95%置信区间 0.09%至 1.02%）相关。开放的检测政策与 CFR 降低 2.23%（95%置信区间 0.21%至 4.25%）相关。整体而言，抗 COVID-19 措施的严格程度与 CFR 无统计学显著相关性，但在采取积极检测政策的高收入国家中，较高的严格指数与较高的 CFR 相关（回归系数β=0.14，95%置信区间 0.01 至 0.27）。心血管疾病死亡率和糖尿病患病率与 CFR 呈负相关。
人口规模与 COVID-19 CFR 之间的关联可能意味着人口众多的国家的医疗保健压力和治疗效率降低。观察到的女性吸烟与 COVID-19 CFR 之间的关联可能归因于女性吸烟者的比例广泛反映了一个国家的收入水平。在有检测需求且医疗资源充足的情况下，严格的隔离和/或封锁措施可能会导致弱势群体的超额死亡。在制定全球联合战略和/或应对 COVID-19 大流行的政策时，应考虑数据的空间依赖性和时间趋势。
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