Shah Md Rafil Tazir, Ahammed Tanvir, Anjum Aniqua, Chowdhury Anisa Ahmed, Suchana Afroza Jannat
Department of Statistics, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.
Biomedical Research Foundation, Dhaka 1230, Bangladesh.
Biosaf Health. 2021 Jun;3(3):164-171. doi: 10.1016/j.bsheal.2021.03.002. Epub 2021 Mar 17.
The crude case fatality rate (CFR), because of the calculation method, is the most accurate when the pandemic is over since there is a possibility of the delay between disease onset and outcomes. Adjusted crude CFR measures can better explain the pandemic situation by improving the CFR estimation. However, no study has thoroughly investigated the COVID-19 adjusted CFR of the South Asian Association For Regional Cooperation (SAARC) countries. This study estimated both survival interval and underreporting adjusted CFR of COVID-19 for these countries. Moreover, we assessed the crude CFR between genders and across age groups and observed the CFR changes due to the imposition of fees on COVID-19 tests in Bangladesh. Using the daily records up to October 9, we implemented a statistical method to remove the delay between disease onset and outcome bias, and due to asymptomatic or mild symptomatic cases, reporting rates lower than 50% (95% CI: 10%-50%) bias in crude CFR. We found that Afghanistan had the highest CFR, followed by Pakistan, India, Bangladesh, Nepal, Maldives, and Sri Lanka. Our estimated crude CFR varied from 3.708% to 0.290%, survival interval adjusted CFR varied from 3.767% to 0.296% and further underreporting adjusted CFR varied from 1.096% to 0.083%. Furthermore, the crude CFRs for men were significantly higher than that of women in Afghanistan (4.034% vs. 2.992%) and Bangladesh (1.739% vs. 1.337%) whereas the opposite was observed in Maldives (0.284% vs. 0.390%), Nepal (0.006% vs. 0.007%), and Pakistan (2.057% vs. 2.080%). Besides, older age groups had higher risks of death. Moreover, crude CFR increased from 1.261% to 1.572% after imposing the COVID-19 test fees in Bangladesh. Therefore, the authorities of countries with higher CFR should be looking for strategic counsel from the countries with lower CFR to equip themselves with the necessary knowledge to combat the pandemic. Moreover, caution is needed to report the CFR.
由于计算方法的原因，粗病死率（CFR）在疫情结束时最为准确，因为疾病发病与结果之间可能存在延迟。调整后的粗CFR测量方法可以通过改进CFR估计来更好地解释疫情形势。然而，尚无研究对南亚区域合作联盟（SAARC）国家的新冠调整后CFR进行全面调查。本研究估计了这些国家新冠的生存间隔和漏报调整后CFR。此外，我们评估了不同性别和年龄组的粗CFR，并观察了孟加拉国因对新冠检测收费而导致的CFR变化。利用截至10月9日的每日记录，我们采用了一种统计方法来消除疾病发病与结果偏差之间的延迟，以及由于无症状或轻症病例导致的粗CFR报告率低于50%（95%CI：10%-50%）的偏差。我们发现，阿富汗的CFR最高，其次是巴基斯坦、印度、孟加拉国、尼泊尔、马尔代夫和斯里兰卡。我们估计的粗CFR在3.708%至0.290%之间，生存间隔调整后的CFR在3.767%至0.296%之间，进一步漏报调整后的CFR在1.096%至0.083%之间。此外，在阿富汗（4.034%对2.992%）和孟加拉国（1.739%对1.337%），男性的粗CFR显著高于女性，而在马尔代夫（0.284%对0.390%）、尼泊尔（0.006%对0.007%）和巴基斯坦（2.057%对2.080%）则观察到相反情况。此外，年龄较大的群体死亡风险更高。此外，孟加拉国实施新冠检测收费后，粗CFR从1.261%升至1.572%。因此，CFR较高国家的当局应向CFR较低的国家寻求战略建议，以获取应对疫情所需的知识。此外，报告CFR时需要谨慎。
