Covid-19 mortality is negatively\xa0associated with test number and government effectiveness

Li-Lin Liang,Hsiu J Ho,Chun-Ying Wu,Ching-Hung Tseng

doi:10.1038/s41598-020-68862-x

Li-Lin Liang, Hsiu J Ho + Show 2 more

Open Access

https://doi.org/10.1038/s41598-020-68862-x

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Abstract

A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries. This study aims to investigate factors associated with cross-country variation in Covid-19 mortality. Covid-19 mortality rate was calculated as number of deaths per 100 Covid-19 cases. To identify factors associated with Covid-19 mortality rate, linear regressions were applied to a cross-sectional dataset comprising 169 countries. We retrieved data from the Worldometer website, the Worldwide Governance Indicators, World Development Indicators, and Logistics Performance Indicators databases. Covid-19 mortality rate was negatively associated with Covid-19 test number per 100 people (RR = 0.92, P = 0.001), government effectiveness score (RR = 0.96, P = 0.017), and number of hospital beds (RR = 0.85, P < 0.001). Covid-19 mortality rate was positively associated with proportion of population aged 65 or older (RR = 1.12, P < 0.001) and transport infrastructure quality score (RR = 1.08, P = 0.002). Furthermore, the negative association between Covid-19 mortality and test number was stronger among low-income countries and countries with lower government effectiveness scores, younger populations and fewer hospital beds. Predicted mortality rates were highly associated with observed mortality rates (r = 0.77; P < 0.001). Increasing Covid-19 testing, improving government effectiveness and increasing hospital beds may have the potential to attenuate Covid-19 mortality.

Highlights

A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries
Among the Covid-19 related factors, one additional Covid-19 screening test per 100 people was associated with a 8% reduction in mortality risk (RR = 0.92; 95% CI 0.87 to 0.96, P = 0.001)
Among the country related factors, a 0.1 increase in government effectiveness score was associated with a 4% reduction in mortality risk (RR = 0.96; 95% CI 0.92 to 0.99, P = 0.017); a percentage point increase in the population aged 65 or older is associated with a 12% increase in mortality risk (RR = 1.12, 95% CI 1.07 to 1.17, P < 0.001)

Summary

Introduction

A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries. Covid-19 mortality rate was negatively associated with Covid-19 test number per 100 people (RR = 0.92, P = 0.001), government effectiveness score (RR = 0.96, P = 0.017), and number of hospital beds (RR = 0.85, P < 0.001). Patient-level studies have shown that Covid-19 mortality can be explained by age, obesity, and underlying diseases, such as hypertension, diabetes, and coronary heart disease, etc.[6,7,8], as well as clinical symptoms, complications, hospital care, previous immunity and virus m utations[9,10]. These findings help health professionals to identify high-risk patients. Increasing Covid-19 testing has been advocated to attenuate its s preading[14]

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