ArticleAnnals of internal medicine2020
The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.
Article in Annals of internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 2 of them syntheses that pooled it.
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Who cites it
63 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- [Mortality in sepsis and septic shock in Germany. Results of a systematic review and meta-analysis].Der Anaesthesist · 2021Pooled it
- Risk of adverse coronavirus disease 2019 outcomes for people living with HIV.AIDS (London, England) · 2021Pooled it
- Timing of Infection as a Key Driver of Racial/Ethnic Disparities in Coronavirus Disease 2019 Mortality Rates During the Prevaccine Period.Open forum infectious diseases · 2025Article
- Estimates of SARS-CoV-2 Hospitalization and Fatality Rates in the Prevaccination Period, United States.Emerging infectious diseases · 2024Article
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- COVID-19-related deaths: a 2-year inter-wave comparison of mortality data from Germany.Infection · 2023Article
- Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure.BMJ global health · 2023Article
- The new combination of oxygen saturation with age shock index predicts the outcome of COVID-19 pneumonia.SAGE open medicine · 2023Article
- The role of booster vaccination in decreasing COVID-19 age-adjusted case fatality rate: Evidence from 32 countries.Frontiers in public health · 2023Article
- Dietary, comorbidity, and geo-economic data fusion for explainable COVID-19 mortality prediction.Expert systems with applications · 2022Article
- Influence of foods and nutrients on COVID-19 recovery: A multivariate analysis of data from 170 countries using a generalized linear model.Clinical nutrition (Edinburgh, Scotland) · 2022Article
- Observational
- Estimating the infection burden of COVID-19 in Malaysia.PLoS neglected tropical diseases · 2022Article
- How German and Italian Laypeople Reason about Distributive Shortages during COVID-19.International journal of environmental research and public health · 2022Article
- Factors influencing medical and nursing students' willingness to care for COVID-19 patients in South Korea: a cross-sectional study.BMC medical education · 2022Article
- Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies.Globalization and health · 2022Article
- Clinical Utility of 4C Mortality Scores among Japanese COVID-19 Patients: A Multicenter Study.Journal of clinical medicine · 2022Article
- Observational
3 more citing papers are in PubMed but not listed here.
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4 authors.
Funding
Abstract
backgroundThere is wide variation in coronavirus disease 2019 (COVID-19) case-fatality rates (CFRs) across countries, leading to uncertainty about the true lethality of the disease. A large part of this variation may be due to the ages of individuals who are tested and identified.
objectiveTo measure the contribution of distortions from the age distributions of confirmed cases to CFRs within and across populations.
designCross-sectional demographic study using aggregate data on COVID-19 cases and deaths by age.
settingPopulation-based data from China, France, Germany, Italy, the Netherlands, South Korea, Spain, Switzerland, and the United States.
participantsAll individuals with confirmed COVID-19, as reported by each country as of 19 April 2020 ( MEASUREMENTS: Age-specific COVID-19 CFRs and age-specific population shares by country.
resultsThe overall observed CFR varies widely, with the highest rates in Italy (9.3%) and the Netherlands (7.4%) and the lowest rates in South Korea (1.6%) and Germany (0.7%). Adjustment for the age distribution of cases explains 66% of the variation across countries, with a resulting age-standardized median CFR of 1.9%. Among a larger sample of 95 countries, the observed variation in COVID-19 CFRs is 13 times larger than what would be expected on the basis of just differences in the age composition of countries. LIMITATION: The age-adjusted rates assume that, conditional on age, COVID-19 mortality among diagnosed cases is the same as that among undiagnosed cases and that individuals of all ages are equally susceptible to severe acute respiratory syndrome coronavirus 2 infection.
conclusionSelective testing and identification of older cases considerably warps estimates of the lethality of COVID-19 within populations and comparisons across countries. Removing age distortions and focusing on differences in age-adjusted case fatality will be essential for accurately comparing countries' performance in caring for patients with COVID-19 and for monitoring the epidemic over time. PRIMARY FUNDING SOURCE: Alexander von Humboldt Foundation.
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