The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.
In: Annals of internal medicine, Jg. 173 (2020-11-03), Heft 9, S. 714-720
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Zugriff:
Background: 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.
Objective: To measure the contribution of distortions from the age distributions of confirmed cases to CFRs within and across populations.
Design: Cross-sectional demographic study using aggregate data on COVID-19 cases and deaths by age.
Setting: Population-based data from China, France, Germany, Italy, the Netherlands, South Korea, Spain, Switzerland, and the United States.
Participants: All individuals with confirmed COVID-19, as reported by each country as of 19 April 2020 ( n = 1 223 261).
Measurements: Age-specific COVID-19 CFRs and age-specific population shares by country.
Results: 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 the basis of just differences in the age composition of countries.
Limitation: The age-adjusted rates assume that, conditional on age, COVID-19 mortality among diagnosed cases is the same as that among undiagnosed cases and that individuals of all ages are equally susceptible to severe acute respiratory syndrome coronavirus 2 infection.
Conclusion: Selective testing and identification of older cases considerably warps estimates of the lethality of COVID-19 within populations and comparisons across countries. Removing age distortions and focusing on differences in age-adjusted case fatality will be essential for accurately comparing countries' performance in caring for patients with COVID-19 and for monitoring the epidemic over time.
Primary Funding Source: Alexander von Humboldt Foundation.
Titel: |
The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.
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Autor/in / Beteiligte Person: | Sudharsanan, N ; Didzun, O ; Bärnighausen, T ; Geldsetzer, P |
Zeitschrift: | Annals of internal medicine, Jg. 173 (2020-11-03), Heft 9, S. 714-720 |
Veröffentlichung: | <2001->: Philadelphia, PA : American College of Physicians--American Society of Internal Medicine ; <i>Original Publication</i>: Philadelphia [etc.] American College of Physicians., 2020 |
Medientyp: | academicJournal |
ISSN: | 1539-3704 (electronic) |
DOI: | 10.7326/M20-2973 |
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