Using the novel mortality-prevalence ratio to evaluate potentially undocumented SARS-CoV-2 infection: Correlational study

Sheng Hsuan Lin, Shih Chen Fu, Chu-Lan Kao*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The high prevalence of COVID-19 has resulted in 200,000 deaths as of early 2020. The corresponding mortality rate among different countries and times varies. Objective: This study aims to investigate the relationship between the mortality rate and prevalence of COVID-19 within a country. Methods: We collected data from the Johns Hopkins Coronavirus Resource Center. These data included the daily cumulative death count, recovered count, and confirmed count for each country. This study focused on a total of 36 countries with over 10,000 confirmed COVID-19 cases. Mortality was the main outcome and dependent variable, and it was computed by dividing the number of COVID-19 deaths by the number of confirmed cases. Results: The results of our global panel regression analysis showed that there was a highly significant correlation between prevalence and mortality (ρ=0.8304; P<.001). We found that every increment of 1 confirmed COVID-19 case per 1000 individuals led to a 1.29268% increase in mortality, after controlling for country-specific baseline mortality and time-fixed effects. Over 70% of excess mortality could be attributed to prevalence, and the heterogeneity among countries' mortality-prevalence ratio was significant (P<.001). Further, our results showed that China had an abnormally high and significant mortality-prevalence ratio compared to other countries (P<.001). This unusual deviation in the mortality-prevalence ratio disappeared with the removal of the data that was collected from China after February 17, 2020. It is worth noting that the prevalence of a disease relies on accurate diagnoses and comprehensive surveillance, which can be difficult to achieve due to practical or political concerns. Conclusions: The association between COVID-19 mortality and prevalence was observed and quantified as the mortality-prevalence ratio. Our results highlight the importance of constraining disease transmission to decrease mortality rates. The comparison of mortality-prevalence ratios between countries can be a powerful method for detecting, or even quantifying, the proportion of individuals with undocumented SARS-CoV-2 infection.

Original languageEnglish
Article numbere23034
JournalJMIR Public Health and Surveillance
Issue number1
StatePublished - Jan 2021


  • China
  • COVID-19
  • Mortality
  • Mortality-prevalence ratio
  • Prevalence
  • Undocumented infection


Dive into the research topics of 'Using the novel mortality-prevalence ratio to evaluate potentially undocumented SARS-CoV-2 infection: Correlational study'. Together they form a unique fingerprint.

Cite this