Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: an ecological study
Open Access
- 3 February 2021
- Vol. 11 (2), e042034
- https://doi.org/10.1136/bmjopen-2020-042034
Abstract
Objective We aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic. Design Ecological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January–May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data. Primary outcome Country-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase. Participants Thirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA. Results Of all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (−0.018 (95% CI −0.034 to –0.002)), were significantly associated with the natural logarithm of the mean death rate. Conclusions International travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.Funding Information
- Aberdeen Clinical Academic Training Scheme (N/A)
This publication has 18 references indexed in Scilit:
- Demographic science aids in understanding the spread and fatality rates of COVID-19Proceedings of the National Academy of Sciences of the United States of America, 2020
- Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatalityScience of The Total Environment, 2020
- Monitoring the COVID-19 epidemic in the context of widespread local transmissionThe Lancet Respiratory Medicine, 2020
- Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysisEuropean Respiratory Journal, 2020
- COVID-19 and smoking: A systematic review of the evidenceTobacco Induced Diseases, 2020
- Potential association between COVID-19 mortality and health-care resource availabilityThe Lancet. Global Health, 2020
- Effectiveness of travel restrictions in the rapid containment of human influenza: a systematic reviewBulletin of the World Health Organization, 2014
- An Ecological Study of the Determinants of Differences in 2009 Pandemic Influenza Mortality Rates between Countries in EuropePLOS ONE, 2011
- Combination strategies for pandemic influenza response - a systematic review of mathematical modeling studiesBMC Medicine, 2009
- Spread of a Novel Influenza A (H1N1) Virus via Global Airline TransportationThe New England Journal of Medicine, 2009