The Contribution of the Age Distribution of Cases to COVID-19 Case Fatality Across Countries : A Nine-Country Demographic Study.
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
COVID-19
Child
Child, Preschool
China
/ epidemiology
Coronavirus Infections
/ mortality
Cross-Sectional Studies
France
/ epidemiology
Germany
/ epidemiology
Humans
Infant
Infant, Newborn
Italy
/ epidemiology
Middle Aged
Netherlands
/ epidemiology
Pandemics
Pneumonia, Viral
/ mortality
Republic of Korea
/ epidemiology
Risk Factors
Spain
/ epidemiology
Switzerland
/ epidemiology
United States
/ epidemiology
Young Adult
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
03 11 2020
03 11 2020
Historique:
pubmed:
24
7
2020
medline:
18
11
2020
entrez:
24
7
2020
Statut:
ppublish
Résumé
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 ( 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 the basis of just differences in the age composition of countries. 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. 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. Alexander von Humboldt Foundation.
Sections du résumé
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 (
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.
Identifiants
pubmed: 32698605
doi: 10.7326/M20-2973
pmc: PMC7397549
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
714-720Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR003143
Pays : United States
Commentaires et corrections
Type : CommentIn
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