ArticlePloS one2020
Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 1 of them a synthesis that pooled it.
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Who cites it
71 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications.European journal of epidemiology · 2020Pooled it
- The Clinical Impact of the Omicron Variant on Octogenarian Hospitalized COVID-19 Patients: The Results from CoviCamp Cohort.Biomedicines · 2025Article
- Revisiting the link between COVID-19 incidence and infection fatality rate during the first pandemic wave.Scientific reports · 2025Article
- Relationship between Commuting Distance Using Public Transportation and the Risk of SARS-CoV-2 Infection in Healthcare Workers in Japan: A Cross-sectional Study.The Kobe journal of medical sciences · 2025Article
- Geospatial modelling of COVID19 mortality in Oman using geographically weighted Poisson regression GWPR.Scientific reports · 2025Article
- Improving case fatality ratio estimates in ongoing pandemics through case-to-death time distribution analysis.Scientific reports · 2025Article
- Facing stress and inflammation: From the cell to the planet.World journal of experimental medicine · 2024Review
- High abundance of butyrate-producing bacteria in the naso-oropharynx of SARS-CoV-2-infected persons in an African population: implications for low disease severity.BMC infectious diseases · 2024Article
- Comparison of fatalities due to COVID-19 and other nonexternal causes during the first five pandemic waves : Results from multiple cause of death statistics in Bavaria.Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2024Article
- Country-specific determinants for COVID-19 case fatality rate and response strategies from a global perspective: an interpretable machine learning framework.Population health metrics · 2024Article
- Article
- Evaluating Spatial, Cause-Specific and Seasonal Effects of Excess Mortality Associated with the COVID-19 Pandemic: The Case of Germany, 2020.Journal of epidemiology and global health · 2023Article
- Variation in mortality burden of the COVID-19 pandemic across federal states in Germany.European journal of public health · 2023Article
- Impact of COVID-19 on Spanish mortality rates in 2020 by age and sex.Journal of public health (Oxford, England) · 2023Article
- The role of universal health coverage and global health security nexus and interplay on SARS-CoV-2 infection and case-fatality rates in Africa : a structural equation modeling approach.Globalization and health · 2023Article
- The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach.Economics and human biology · 2023Review
- Identifying age- and sex-specific COVID-19 mortality trends over time in six countries.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- A continuous age-specific standardized mortality ratio for estimating the unascertained rates in the early epidemic of COVID-19 in different regions.Journal of applied statistics · 2023Article
- The role of booster vaccination in decreasing COVID-19 age-adjusted case fatality rate: Evidence from 32 countries.Frontiers in public health · 2023Article
- COVID-19 vaccination and case fatality rates: a case report in a Brazilian municipality.Cadernos de saude publica · 2023Article
11 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy, Germany, Spain, and New York City over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late June 2020, CFRs varied from 2.2% in South Korea to 14.0% in Italy. The age-structure of detected cases often explains more than two-thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 14.0% between March 9 and June 30, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.
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