ArticleThe Science of the total environment2022
Variations of COVID-19 mortality are affected by economic disparities across countries.
Article in The Science of the total environment, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis.Frontiers in medicine · 2024Pooled it
- A multi-phase, multi-method assessment of national COVID-19 vaccination performance with equity analysis.Scientific reports · 2026Article
- Excess Mortality and Containment Performance During the COVID-19 Pandemic: Evidence From 34 Countries.American journal of public health · 2025Article
- Article
- Mechanistic insights into traditional Chinese medicine for viral pneumonia treatment: signaling pathway perspectives.Frontiers in pharmacology · 2025Review
- Article
- Disparities by sex, race, and region in acute myocardial infarction-related outcomes during the early COVID-19 pandemic: the national inpatient sample analysis.American journal of cardiovascular disease · 2024Article
- Global trends in COVID-19 incidence and case fatality rates (2019-2023): a retrospective analysis.Frontiers in public health · 2024Article
- Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view.EClinicalMedicine · 2023Review
- Article
- The spatial linkage mechanism: medical level, public health security, and economic climate from 19 OECD EU countries.Frontiers in public health · 2023Article
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhen the COVID-19 case number reaches a maximum in a country, its capacity and management of health system face greatest challenge.
methodsWe performed a cross-sectional study on data of turning points for cases and deaths for the first three waves of COVID-19 in countries with more than 5000 cumulative cases, as reported by Worldometers and WHO Coronavirus (COVID-19) Dashboard. We compared the case fatality rates (CFRs) and time lags (in unit of day) between the turning points of cases and deaths among countries in different development stages and potential influence factors. As of May 10, 2021, 106 out of 222 countries or regions (56%) reported more than 5000 cases. Approximately half of them have experienced all the three waves of COVID-19 disease. The average mortality rate at the disease turning point was 0.038 for the first wave, 0.020 for the second wave, and 0.023 for wave 3. In high-income countries, the mortality rates during the first wave are higher than that of the other income levels. However, the mortality rates during the second and third waves of COVID-19 were much lower than those of the first wave, with a significant reduction from 5.7% to 1.7% approximately 70%. At the same time, high-income countries exhibited a 2-fold increase in time lags during the second and the third waves compared to the first wave, suggesting that the periods between the cases and deaths turning point extended. High rates in the first wave in developed countries are associated to multiple factors including transportation, population density, and aging populations. In upper middle- and lower middle-income countries, the decreasing of mortality rates in the second and third waves were subtle or even reversed, with increased mortality during the following waves. In the upper and lower middle-income countries, the time lags were about 50% of the durations observed from high-income countries.
interpretationEconomy and medical resources affect the efficiency of COVID-19 mitigation and the clinical outcomes of the patients. The situation is likely to become even worse in the light of these countries' limited ability to combat COVID-19 and prevent severe outcomes or deaths as the new variant transmission becomes dominant.
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