ArticleBMJ open2020
COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 111 papers, 4 of them syntheses that pooled it.
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Who cites it
111 citing papers in PubMed, 4 syntheses or guidelines pooled it, 214 citations in OpenAlex.
- Gini coefficient, GDP per capita and COVID-19 mortality: a systematic review of ecologic studies.BMC public health · 2025Pooled it
- Methods Used in the Spatial and Spatiotemporal Analysis of COVID-19 Epidemiology: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- The impact of geo-environmental factors on global COVID-19 transmission: A review of evidence and methodology.The Science of the total environment · 2022Pooled it
- Dupilumab therapy in atopic dermatitis is safe during COVID-19 infection era: A systematic review and meta-analysis of 1611 patients.Dermatologic therapy · 2022Pooled it
- Excess mortality in Europe estimated by EuroMOMO during the COVID-19 pandemic and previous influenza seasons.Nature communications · 2026Article
- Mapping the burden of COVID-19 infections and estimating the contribution of socioeconomic factors: a cross-sectional study.Archives of public health = Archives belges de sante publique · 2025Article
- Epidemic evolutionarily stable strategies within an age-structured host population.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- An ecological study of COVID-19 outcomes among Florida counties.BMC public health · 2025Article
- US state-level containment policies not associated with food insecurity changes during the early COVID-19 pandemic: a multilevel analysis.Public health nutrition · 2025Article
- Addressing data quality issues to assess clinical and epidemiological risk factors for COVID-19 among documented cases in Liberia: a single-centre, retrospective, observational study.BMJ public health · 2024Article
- Epidemiology of acute hypoxaemic respiratory failure in Australian and New Zealand intensive care units during 2005-2022. A binational, registry-based study.Intensive care medicine · 2024Article
- The spatial-temporal variations and influencing factors of COVID-19 case fatality rate: a worldwide study in 30 countries from February 2021 to May 2022.Epidemiology and infection · 2024Article
- Impact of non-pharmaceutical interventions on COVID-19 incidence and deaths: cross-national natural experiment in 32 European countries.BMC public health · 2024Article
- The landscape of the COVID-19 pandemic in Poland emerging from epidemiological and genomic data.Scientific reports · 2024Article
- Review
- Spatio-temporal dynamics and distributional trend analysis of African swine fever outbreaks (2020-2021) in North-East India.Tropical animal health and production · 2024Article
- "They Don't Care If We Live or Die": A Qualitative Analysis Examining the US Immigration System's Treatment of Undocumented Communities during the COVID-19 Pandemic.Ethnicity & disease · 2024Article
- Lassa fever cases and mortality in Nigeria: Quantile Regression vs. Machine Learning Models.Journal of public health in Africa · 2023Article
- Patterns of protection, infection, and detection: Country-level effectiveness of COVID-19 vaccination in reducing mortality worldwide.Public health in practice (Oxford, England) · 2023Article
- Income inequality and its association with COVID-19 cases and deaths: a cross-country analysis in the Eastern Mediterranean region.BMJ global health · 2023Article
51 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.
designPublicly available register-based ecological study.
settingTwo hundred and nine countries/territories in the world.
participantsAggregated data including 10 445 656 confirmed COVID-19 cases. PRIMARY AND SECONDARY OUTCOME MEASURES: COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.
resultsThe average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.
conclusionThe association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.
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