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Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.

ABSTRACT: The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy, Germany, Spain, and New York City over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late June 2020, CFRs varied from 2.2% in South Korea to 14.0% in Italy. The age-structure of detected cases often explains more than two-thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 14.0% between March 9 and June 30, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.

SUBMITTER: Dudel C

PROVIDER: S-EPMC7482960 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.

Dudel Christian C Riffe Tim T Acosta Enrique E van Raalte Alyson A Strozza Cosmo C Myrskylä Mikko M

PloS one 20200910 9

The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and N ...[more]

PMID: 32913365

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Project description:Importance:If changes over time in trauma care apply to both firearm injuries and motor vehicle crashes (MVCs) similarly, differences in mechanism-specific case-fatality trends may suggest changes over time in injury severity. Objectives:To analyze national trends in case-fatality percentages at levels I and II trauma centers for injuries due to MVC, firearm assault, self-inflicted firearm injury, and unintentional firearm injury by age and to analyze trends in injury severity scores (ISSs) and the percentage of out-of-hospital deaths by mechanism. Design, Setting, and Participants:From November 15, 2017, to July 4, 2018, repeated cross-sectional measures analysis of 1 335 044 patients treated at level I or II trauma centers from January 1, 2003, through December 31, 2013, was conducted using 2 data sources: the National Trauma Data Bank National Sample Program, with survey weights to estimate annual median ISS, total injuries and total deaths at levels I and II trauma centers, and the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research for percentages of out-of-hospital deaths. Main Outcome Measures:The main outcome was annual case-fatality percentage (total died/total injured), calculated by mechanism across 3 age groups (15-34 years, 35-54 years, and ≥55 years) and 5 categories of ISS (1-15 [mild] 16-24, 25-40, 41-66, and 67-75 [severe]). Linear regression was performed to estimate annual trends in case-fatality percentage by mechanism, age group, and ISS. Annual trends in percentages of out-of-hospital deaths and median ISSs by mechanism were estimated. Sensitivity analyses included the Durbin-Watson statistic for autocorrelation and Prais-Winsten regression models. Results:Among 1 335 044 patients treated at level I or II trauma centers, self-inflicted firearm injury had a case-fatality percentage of 42.8%, and assault with a firearm had a case-fatality percentage of 11.1%, the 2 highest of the injuries studied. The injury case-fatality percentage was lower each year for MVCs but did not change for any firearm intent overall or for any age group. Overall, median ISS increased annually for firearm suicide (0.31; 95% CI, 0.00-0.61). The annual percentage of out-of-hospital deaths was lower each year for MVCs (-0.24; 95% CI, -0.43 to -0.05) but not for any firearm intents. In sensitivity analyses, the annual percentage of out-of-hospital deaths for MVCs no longer showed a decline. Conclusions and Relevance:Stagnant case-fatality percentages for firearm injuries juxtaposed to improvements for MVCs across age-groups and ISS categories suggests worsening severity of firearm injuries over the study period.

Dataset Information

Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.

Publications

Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.

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