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Abstract：
To investigate the influence of demographic and socioeconomic factors on the COVID-19 case-fatality rate (CFR) globally.
Publicly available register-based ecological study.
Two hundred and nine countries/territories in the world.
Aggregated data including 10 445 656 confirmed COVID-19 cases.
COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.
The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.
The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.
Publicly available register-based ecological study.
Two hundred and nine countries/territories in the world.
Aggregated data including 10 445 656 confirmed COVID-19 cases.
COVID-19 CFR and crude cause-specific death rate were calculated using country-level data from the Our World in Data website.
The average of country/territory-specific COVID-19 CFR is about 2%-3% worldwide and higher than previously reported at 0.7%-1.3%. A doubling in size of a population is associated with a 0.48% (95% CI 0.25% to 0.70%) increase in COVID-19 CFR, and a doubling in the proportion of female smokers is associated with a 0.55% (95% CI 0.09% to 1.02%) increase in COVID-19 CFR. The open testing policies are associated with a 2.23% (95% CI 0.21% to 4.25%) decrease in CFR. The strictness of anti-COVID-19 measures was not statistically significantly associated with CFR overall, but the higher Stringency Index was associated with higher CFR in higher-income countries with active testing policies (regression coefficient beta=0.14, 95% CI 0.01 to 0.27). Inverse associations were found between cardiovascular disease death rate and diabetes prevalence and CFR.
The association between population size and COVID-19 CFR may imply the healthcare strain and lower treatment efficiency in countries with large populations. The observed association between smoking in women and COVID-19 CFR might be due to the finding that the proportion of female smokers reflected broadly the income level of a country. When testing is warranted and healthcare resources are sufficient, strict quarantine and/or lockdown measures might result in excess deaths in underprivileged populations. Spatial dependence and temporal trends in the data should be taken into account in global joint strategy and/or policy making against the COVID-19 pandemic.
摘要：
探讨全球人口统计学和社会经济因素对COVID-19病死率（CFR）的影响。
公开可用的基于注册的生态研究。
世界上有九个国家/地区。
汇总数据包括10445656例确诊COVID-19病例。
COVID-19CFR和粗略的特定原因死亡率是使用“数据中的我们的世界”网站上的国家级数据计算的。
特定国家/地区的COVID-19CFR在全球范围内约为2%-3%，高于先前报告的0.7%-1.3%。人口规模增加一倍与COVID-19CFR增加0.48%(95%CI0.25%至0.70%)相关，女性吸烟者比例增加一倍与COVID-19CFR增加0.55%(95%CI0.09%至1.02%)相关。开放测试策略与CFR下降2.23%(95%CI0.21%至4.25%)相关。抗COVID-19措施的严格性与总体CFR无统计学意义，但在采用积极检测政策的高收入国家,较高的严谨性指数与较高的CFR相关(回归系数β=0.14,95%CI0.01~0.27).发现心血管疾病死亡率和糖尿病患病率与CFR之间存在负相关。
人口规模与COVID-19CFR之间的关联可能暗示了人口众多国家的医疗压力和较低的治疗效率。观察到的女性吸烟与COVID-19CFR之间的关联可能是由于发现女性吸烟者的比例广泛反映了一个国家的收入水平。当测试得到保证并且医疗保健资源充足时，严格的隔离和/或封锁措施可能会导致弱势群体过度死亡。在制定针对COVID-19大流行的全球联合战略和/或政策时，应考虑数据中的空间依赖性和时间趋势。
公开可用的基于注册的生态研究。
世界上有九个国家/地区。
汇总数据包括10445656例确诊COVID-19病例。
COVID-19CFR和粗略的特定原因死亡率是使用“数据中的我们的世界”网站上的国家级数据计算的。
特定国家/地区的COVID-19CFR在全球范围内约为2%-3%，高于先前报告的0.7%-1.3%。人口规模增加一倍与COVID-19CFR增加0.48%(95%CI0.25%至0.70%)相关，女性吸烟者比例增加一倍与COVID-19CFR增加0.55%(95%CI0.09%至1.02%)相关。开放测试策略与CFR下降2.23%(95%CI0.21%至4.25%)相关。抗COVID-19措施的严格性与总体CFR无统计学意义，但在采用积极检测政策的高收入国家,较高的严谨性指数与较高的CFR相关(回归系数β=0.14,95%CI0.01~0.27).发现心血管疾病死亡率和糖尿病患病率与CFR之间存在负相关。
人口规模与COVID-19CFR之间的关联可能暗示了人口众多国家的医疗压力和较低的治疗效率。观察到的女性吸烟与COVID-19CFR之间的关联可能是由于发现女性吸烟者的比例广泛反映了一个国家的收入水平。当测试得到保证并且医疗保健资源充足时，严格的隔离和/或封锁措施可能会导致弱势群体过度死亡。在制定针对COVID-19大流行的全球联合战略和/或政策时，应考虑数据中的空间依赖性和时间趋势。
