The Association between Healthcare Resources, Non-Communicable Diseases, and COVID-19 Mortality: An Ecological Study of 162 Countries

Abstract

Background: To provide an overview of the worldwide association between hospital beds, the burden of non-communicable diseases (NCDs), and COVID-19 mortality.Methods: We extracted data regarding COVID-19 deaths and cases from the Our World in Data as of November 21, 2020. We also obtained the following data:1) NCDs disability-adjusted life years (DALYs), health-adjusted life expectancy, and the health access and quality index from the Global Burden of Disease study; 2) the number of hospital beds, physicians, nurses and midwives per population, and out-of-pocket payments from the WHO website; 3) income levels and population density from the World Bank database. Using the principal component approach and a multilevel generalised linear model, we examined these variables’ independent associations with COVID-19 mortality rate ratio (MRR).Findings: During the study period, 17.62 COVID-19 deaths per 100,000 population were reported globally (1.20 in low-, 13.43 in lower-middle-, 14.14 in upper-middle-, and 46.72 in high-income countries). Median age increased COVID-19 mortality. Hospital beds were associated with reduced COVID-19 mortality (MRR=0.62; 95% CI: 0.59, 0.64) globally. During COVID-19 peak periods, despite a decreasing trend in COVID-19 MRR with increasing beds in high-income countries, the odds of mortality remained high even within the highest percentile of hospital beds (MRR=2.99 for 20th - 40th and 1.51 for >60 th bed percentile, respectively). On the contrary, in middle-income countries, we observed an inverse association between the number of hospital beds and COVID-19 mortality in both periods. NCD DALYs were associated with increased COVID-19 deaths, particularly during peak mortality periods in high-income countries. Death-to-case ratio increased by approximately two times during the peak vs non-peak mortality periods.Interpretations: COVID-19 is a syndemic interacting with non-communicable diseases and not only a pandemic. A comprehensive national healthcare plan against COVID-19 spread should include adequate measures to protect vulnerable patients with pre-existing chronic conditions.Funding: None.Declaration of Interests: The authors declare no conflicts of interest to disclose.