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. 2021 Feb;49(1):111-116.
doi: 10.1007/s15010-020-01538-w. Epub 2020 Oct 24.

Older age groups and country-specific case fatality rates of COVID-19 in Europe, USA and Canada

Christian Hoffmann  1   2 , Eva Wolf  3
Affiliations

Older age groups and country-specific case fatality rates of COVID-19 in Europe, USA and Canada

Christian Hoffmann et al. Infection.2021 Feb.

Abstract

Purpose: To evaluate the association between the percentages of older age groups among confirmed SARS-CoV-2 infections and the country-specific case fatality rate (CFR).

Methods: This ecological study analyzed data from the 20 most severely affected European countries, USA and Canada, in which national health authorities provided data on age distribution and gender among confirmed SARS-CoV-2 cases and deaths.

Results: The proportion of individuals older than 70 years among confirmed SARS-CoV-2 cases differed markedly between the countries, ranging from 4.9 to 40.4%. There was a strong linear association between the proportion of individuals older than 75 years and the country-specific CFRs (R2 = 0.803 for all countries, R2 = 0.961 after exclusion of three countries with incongruent data). Each 5% point increase of this older age group among confirmed SARS-CoV-2 cases was associated with an increase in CFR of 2.5% points (95% CI 1.9-3.1).

Conclusion: Data from 20 European countries and the USA and Canada showed that the variance of crude CFR of COVID-19 is predominantly (80-96%) determined by the proportion of older individuals who are diagnosed with SARS-CoV-2. The age distribution of SARS-CoV-2 infections is still far from being homogeneous. Detailed demographic data have to be taken into account in all the analyses on COVID-19-associated mortality. We urgently call for standardized data collection by national health authorities.

Keywords: Age distribution; COVID-19; Case fatality rate; SARS-CoV-2.

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Conflict of interest statement

The authors C.H. and E.W. certify that they had no conflict of interest that could affect their objectivity. The authors declare no support from any organization for the submitted work and no financial relationships with any organization that might have an interest in the submitted work in the previous 3 years. There are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Association between case fatality rate (CFR) and the proportion of persons over 75 years of age among all confirmed SARS-CoV-2 cases (R2 = 0.8034, p < 0.0001). The circle sizes reflect the country-specific numbers of COVID-19-associated deaths per million habitants; the linear fit prediction plot with a 95% confidence interval was estimated by weighted linear regression (weight = total number of COVID-19-associated deaths)
Fig. 2
Fig. 2
Age- and gender-specific CFR (percentage) for the eight countries in which these data were available. The relative risk (or risk ratio; i.e., RR) for men compared to women was highest in younger age groups. In individuals aged < 60 years, 60–79 years and > 80 years, the estimated overall RR for men versus women was 2.65 (95% CI 2.18–3.21), 1.73 (1.55–1.93) and 1.50 (1.36–1.65), respectively
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References

    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720. doi: 10.1056/NEJMoa2002032. - DOI - PMC - PubMed
    1. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020;323:1335. doi: 10.1001/jama.2020.4344. - DOI - PubMed
    1. Wu JT, Leung K, Bushman M. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med. 2020;26:506–510. doi: 10.1038/s41591-020-0822-7. - DOI - PMC - PubMed
    1. Esteve A, Permanyer I, Boertien D, Vaupel JW. National age and coresidence patterns shape COVID-19 vulnerability. Proc Natl Acad Sci USA. 2020;23:202008764. - PMC - PubMed
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