The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.

Annals of Internal Medicine
Nikkil SudharsananPascal Geldsetzer

Abstract

There 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. To measure the contribution of distortions from the age distributions of confirmed cases to CFRs within and across populations. Cross-sectional demographic study using aggregate data on COVID-19 cases and deaths by age. Population-based data from China, France, Germany, Italy, the Netherlands, South Korea, Spain, Switzerland, and the United States. All individuals with confirmed COVID-19, as reported by each country as of 19 April 2020 (n = 1 223 261). Age-specific COVID-19 CFRs and age-specific population shares by country. The 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...Continue Reading

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