A multivariate analysis of risk factors associated with death by Covid-19 in the USA, Italy, Spain, and Germany
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REVIEW ARTICLE
A multivariate analysis of risk factors associated with death by Covid-19 in the USA, Italy, Spain, and Germany Alexandre de Fátima Cobre 1 & Beatriz Böger 1 & Raquel de Oliveira Vilhena 2 Josiane Marlei Muller Fernandes dos Santos 1 & Fernanda Stumpf Tonin 1
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Mariana Millan Fachi 1
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Received: 13 July 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim Our aim was to investigate the risk factors associated with death from COVID-19 in four countries: The USA, Italy, Spain, and Germany. Subject and methods We used data from the Institute for Health Metrics and Evaluation with projection information from January– August 2020. A multivariate analysis of logistic regression was performed. The following factors were analyzed (per day): number of beds needed for the hospital services, number of intensive care units (ICU) beds required, number of ventilation devices, number of both hospital and ICU admissions due to COVID-19. Nagelkerke’s R2 coefficient of determination was used to evaluate the model’s predictive ability. The quality of the model’s fit was assessed by the Hosmer–Lemeshow and the chi-square tests. Results Among the evaluated countries, Italy presented greater need for ICU beds/day (≤ 98; OR = 2315.122; CI 95% [334.767– 16,503.502]; p < 0.001) and daily ventilation devices (≤ 118; OR = 1784.168; CI 95% [250.217–12,721.995]; p < 0.001). It is expected that both Italy and Spain have a higher ICU admission rate due to COVID-19 (n = 14/day). Spain will need more beds/day (≤ 357; OR = 146.838; CI 95% [113.242–190.402]; p < 0.001) and probably will have a higher number of daily hospital admissions (n = 48/ day). All the above-mentioned factors have an important impact on patients’ mortality due to COVID-19 in all four countries. Conclusions Further investments in hospitals’ infrastructure, as well as the development of innovative devices for patient’s ventilation, are paramount to fight the pandemic in the USA, Italy, Spain, and Germany. Keywords COVID-19 . Risk factors . USA . Italy . Spain . Germany
Introduction The present study was carried out on April 19, 2020, then all the data used in this study refer to the period from the beginning of the COVID-19 pandemic to the month of April of this year. The World Health Organization recorded more than 4 million confirmed cases and 224 thousand deaths by the new Coronavirus disease 2019 (COVID-19) in more than 208
countries. The largest number of confirmed cases was reported by the United States of America (USA) (n = 1,060,572), Spain (n = 212,917), Italy (n = 203,597), France (n = 128,442), and Germany (n = 161,187) (Arabi et al. 2020; WHO 2020a). The exponential increase in the number of infected individuals, especially critically ill patients, is challenging public health systems worldwide. The infections caused by the SARS-COV-2 virus can be asymptomatic or cause mild
* Beatriz Böger [email protected]
Josiane Marlei Muller Fernandes dos Santos [email protected] Fer
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