Predictors of COVID-19 Case Fatality Rate in Highly Populated Developed Countries During the Emergence of the Delta Variant

Abstract

By September 2021 the outbreak of the COVID-19 caused 228.19 million confirmed cases and 4.7 million deaths globally. Mortality measures are frequently used to estimate the severity of a pandemic. Among them is the Case Fatality Rate (CFR). Some mathematical models were developed to estimate the impact of specific factors on the disease’s mortality. These models were developed before the COVID-19 vaccines were administrated, and therefore did not consider the vaccines influence on COVID-19 fatality. Moreover, some other factors associated with COVID-19 mortality such as diabetes and cardiovascular mortality were not included in these models. This study offers a mathematical model with some potential predictors of COVID-19 CFR during the fourth pandemic wave caused by the Delta variant. To evaluate these predictors, demographic and clinical information for 10 highly populated developed countries was retrieved from a real-time available website. Demographic data included population density, percent of population above age 65, GDP per capita, and percent of smoking. Clinical data included diabetes prevalence, cardiovascular death rate, percent of fully vaccinated population, and CFR. Single linear regressions were conducted to assess the association of each potential predictor with CFR. A backward multiple linear regression was conducted to identify the most parsimonious combination of the independent variables of this study predicting CFR. The model developed in this study suggests that percent of population above age 65, and cardiovascular death rate have a positive effect on CFR, i.e., they are associated with increased COVID-19 fatality rate during the fourth wave. In addition, GDP per capita has a negative effect on CFR, i.e. – higher GDP per capita is associated with lower fatality rate during COVID-19 fourth wave. Moreover, single linear regressions show a strong negative association between percent of fully vaccinated people in each country and CFR. This model sheds light on several potential demographic and clinical factors which may predict CFR in highly populated developed countries during the emergence of the Delta variant. Vaccination in accordance with the recommendations is recommended to reduce COVID-19 mortality.