Older age groups and country-specific case fatality rates of COVID-19 in Europe, USA and Canada
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ORIGINAL PAPER
Older age groups and country‑specific case fatality rates of COVID‑19 in Europe, USA and Canada Christian Hoffmann1,2 · Eva Wolf3 Received: 12 August 2020 / Accepted: 5 October 2020 © The Author(s) 2020
Abstract Purpose To evaluate the association between the percentages of older age groups among confirmed SARS-CoV-2 infections and the country-specific case fatality rate (CFR). Methods This ecological study analyzed data from the 20 most severely affected European countries, USA and Canada, in which national health authorities provided data on age distribution and gender among confirmed SARS-CoV-2 cases and deaths. Results The proportion of individuals older than 70 years among confirmed SARS-CoV-2 cases differed markedly between the countries, ranging from 4.9 to 40.4%. There was a strong linear association between the proportion of individuals older than 75 years and the country-specific CFRs (R2 = 0.803 for all countries, R2 = 0.961 after exclusion of three countries with incongruent data). Each 5% point increase of this older age group among confirmed SARS-CoV-2 cases was associated with an increase in CFR of 2.5% points (95% CI 1.9–3.1). Conclusion Data from 20 European countries and the USA and Canada showed that the variance of crude CFR of COVID19 is predominantly (80–96%) determined by the proportion of older individuals who are diagnosed with SARS-CoV-2. The age distribution of SARS-CoV-2 infections is still far from being homogeneous. Detailed demographic data have to be taken into account in all the analyses on COVID-19-associated mortality. We urgently call for standardized data collection by national health authorities. Keywords SARS-CoV-2 · COVID-19 · Case fatality rate · Age distribution
Introduction In the current pandemic, the country-specific crude case fatality rates (CFRs), the percentage of COVID-19-associated deaths among confirmed SARS-CoV-2 infections, have been the subject of much speculation. Although it became quickly clear that older age is a major risk factor for mortality [1, 2] and that in particular an age of over 70 years is Electronic supplementary material The online version of this article (https://doi.org/10.1007/s15010-020-01538-w) contains supplementary material, which is available to authorized users. * Christian Hoffmann hoffmann@ich‑hamburg.de 1
ICH Study Center, 20146 Hamburg, Germany
2
Department of Medicine II, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
3
MUC Research GmbH, 80335 Munich, Germany
associated with a markedly higher CFR [3, 4], many other factors contributing to regional differences throughout the world have been discussed in recent months. These factors include not only differences in the overall age structure of the general population of a country and coresidence patterns [5], but also comorbidity burden, obesity prevalence and smoking habits [6] as well as societal and social psychological factors [7]. Others include heterogeneity in testing and reporting approaches [8], variations in health
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