BACKGROUND: The numbers of coronavirus disease 2019 (COVID-19) deaths per million people differ widely across countries. Often, the causal effects of interventions taken by authorities are unjustifiably concluded based on the comparison of pure mortalities in countries where interventions consisting different strategies have been taken. Moreover, the possible effects of other factors are only rarely considered. METHODS: We used data from open databases (European Centre for Disease Prevention and Control, World Bank Open Data, The BCG World Atlas) and publications to develop a model that could largely explain the differences in cumulative mortality between countries using non-interventional (mostly socio-demographic) factors. RESULTS: Statistically significant associations with the logarithmic COVID-19 mortality were found with the following: proportion of people aged 80 years and above, population density, proportion of urban population, gross domestic product, number of hospital beds per population, average temperature in March and incidence of tuberculosis. The final model could explain 67% of the variability. This finding could also be interpreted as follows: less than a third of the variability in logarithmic mortality differences could be modified by diverse non-pharmaceutical interventions ranging from case isolation to comprehensive measures, constituting case isolation, social distancing of the entire population and closure of schools and borders. CONCLUSIONS: In particular countries, the number of people who will die from COVID-19 is largely given by factors that cannot be drastically changed as an immediate reaction to the pandemic and authorities should focus on modifiable variables, e.g. the number of hospital beds.

Department of Paediatrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Probability and Mathematical Statistics Faculty of Mathematics and Physics Charles University Prague Czech Republic

See more in PubMed

Weissman GE, Crane-Droesch A, Chivers C, et al.Locally informed simulation to predict hospital capacity needs during the COVID-19 pandemic. Ann Intern Med 2020. PubMed

Curtis N, Sparrow A, Ghebreyesus TA, Netea MG. Considering BCG vaccination to reduce the impact of COVID-19. Lancet 2020;395:1545–6. PubMed PMC

Tobias A, Molina T. Is temperature reducing the transmission of COVID-19? Environ Res 2020;186:109553.. PubMed PMC

Zhou F, Yu T, Du R, et al.Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. PubMed PMC

Schiffrin EL, Flack JM, Ito S, et al.Hypertension and COVID-19. Am J Hypertens 2020;33:373–4. PubMed PMC

Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: knowledge in progress. Diabetes Res Clin Pract 2020;162:108142.. PubMed PMC

Harrell FE. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. Springer International Publishing, 2015.

Läuter H, Cook RDS. Weisberg: Residuals and Influence in Regression. New York, London: Chapman and Hall, 1982. VIII, 229 pp., £12. Biom J 1985;27:80.

Skórka P, Grzywacz B, Moroń D, Lenda M. The macroecology of the COVID-19 pandemic in the Anthropocene. PLoS One 2020;15:e0236856.. PubMed PMC

Dowd JB, Andriano L, Brazel DM, et al.Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci USA 2020;117:9696–8. PubMed PMC

Haider N, Yavlinsky A, Chang YM, et al.The Global Health Security index and Joint External Evaluation score for health preparedness are not correlated with countries' COVID-19 detection response time and mortality outcome. Epidemiol Infect 2020;148:e210.. PubMed PMC

Khan JR, Awan N, Islam MM, Muurlink O. Healthcare capacity, health expenditure, and civil society as predictors of COVID-19 case fatalities: a global analysis. Front Public Health 2020;8:347. PubMed PMC

Asfahan S, Shahul A, Chawla G, et al.Early trends of socio-economic and health indicators influencing case fatality rate of COVID-19 pandemic. Monaldi Arch Chest Dis 2020;90. PubMed

Gangemi S, Billeci L, Tonacci A. Rich at risk: socio-economic drivers of COVID-19 pandemic spread. Clin Mol Allergy 2020;18:12.. PubMed PMC

Daoust JF. Elderly people and responses to COVID-19 in 27 Countries. PLoS One 2020;15:e0235590.. PubMed PMC

Roy S, Khalse M. Epidemiological determinants of COVID-19-related patient outcomes in different countries and plan of action: a retrospective analysis. Cureus 2020;12:e8440.. PubMed PMC

Ergonul O, Akyol M, Tanriover C, et al.National case fatality rates of the COVID-19 pandemic. Clin Microbiol Infect 2020. PubMed PMC

Arsalan M, Mubin O, Alnajjar F, Alsinglawi B. COVID-19 Global Risk: expectation vs. Reality. Int J Environ Res Public Health 2020;17. PubMed PMC

Hashim MJ, Alsuwaidi AR, Khan G. Population Risk Factors for COVID-19 Mortality in 93 Countries. J Epidemiol Glob Health 2020;10:204–8. PubMed PMC

Horobet A, Simionescu AA, Dumitrescu DG, Belascu L. Europe's War against COVID-19: a map of countries' disease vulnerability using mortality indicators. Int J Environ Res Public Health 2020;17. PubMed PMC

Fountoulakis KN, Fountoulakis NK, Koupidis SA, Prezerakos PE. Factors determining different death rates because of the COVID-19 outbreak among countries. J Public Health (Oxf) 2020. PubMed PMC

Sudharsanan N, Didzun O, Barnighausen T, Geldsetzer P. The contribution of the age distribution of cases to COVID-19 case fatality across countries: a 9-country demographic study. Ann Intern Med 2020;173:714–20. PubMed PMC

Flaxman S, Mishra S, Gandy A, et al.; Imperial College COVID-19 Response Team. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature 2020;584:257–61. PubMed

Gerli AG, Centanni S, Miozzo MR, et al.COVID-19 mortality rates in the European Union, Switzerland, and the UK: effect of timeliness, lockdown rigidity, and population density. Minerva Med 2020;111. PubMed

Lin TPH, Wan KH, Huang SS, et al.Death tolls of COVID-19: where come the fallacies and ways to make them more accurate. Glob Public Health 2020;15:1582–7. PubMed

Kisa S, Kisa A. Under-reporting of COVID-19 cases in Turkey. Int J Health Plann Manage 2020;35:1009–13. PubMed PMC