ArticleEpidemiology and infection2020
Ecologic association between influenza and COVID-19 mortality rates in European countries.
Article in Epidemiology and infection, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Vaccination against influenza viruses reduces infection, not hospitalization or death, from respiratory COVID-19: A systematic review and meta-analysis.Journal of medical virology · 2024Pooled it
- Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years.Oral diseases · 2025Article
- Beyond the surface: accounting for confounders in understanding the link between collectivism and COVID-19 pandemic in the United States.BMC public health · 2023Article
- Correlation between country-level numbers of COVID-19 cases and mortalities, and country-level characteristics: A global study.Scandinavian journal of public health · 2022Article
- Age-specific Mortality Associated with COVID-19 and Seasonal Influenza in Japan: Using Multiple Population-based Databases.Annals of clinical epidemiology · 2022Article
- Impact that the COVID-19 pandemic on routine childhood vaccinations and challenges ahead: A narrative review.Acta paediatrica (Oslo, Norway : 1992) · 2021Review
- Exposure to Perfluoroalkyl Substances and Mortality for COVID-19: A Spatial Ecological Analysis in the Veneto Region (Italy).International journal of environmental research and public health · 2021Article
- COVID-19 Is Not the Flu: Four Graphs From Four Countries.Frontiers in public health · 2021Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Ecologic studies investigating COVID-19 mortality determinants, used to make predictions and design public health control measures, generally focused on population-based variable counterparts of individual-based risk factors. Influenza is not causally associated with COVID-19, but shares population-based determinants, such as similar incidence/mortality trends, transmission patterns, efficacy of non-pharmaceutical interventions, comorbidities and underdiagnosis. We investigated the ecologic association between influenza mortality rates and COVID-19 mortality rates in the European context. We considered the 3-year average influenza (2014-2016) and COVID-19 (31 May 2020) crude mortality rates in 34 countries using EUROSTAT and ECDC databases and performed correlation and regression analyses. The two variables - log transformed, showed significant Spearman's correlation ρ = 0.439 (P = 0.01), and regression coefficients, b = 0.743 (95% confidence interval, 0.272-1.214; R2 = 0.244; P = 0.003), b = 0.472 (95% confidence interval, 0.067-0.878; R2 = 0.549; P = 0.02), unadjusted and adjusted for confounders (population size and cardiovascular disease mortality), respectively. Common significant determinants of both COVID-19 and influenza mortality rates were life expectancy, influenza vaccination in the elderly (direct associations), number of hospital beds per population unit and crude cardiovascular disease mortality rate (inverse associations). This analysis suggests that influenza mortality rates were independently associated with COVID-19 mortality rates in Europe, with implications for public health preparedness, and implies preliminary undetected SARS-CoV-2 spread in Europe.
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