TY - JOUR
T1 - Using the novel mortality-prevalence ratio to evaluate potentially undocumented SARS-CoV-2 infection
T2 - Correlational study
AU - Lin, Sheng Hsuan
AU - Fu, Shih Chen
AU - Kao, Chu-Lan
N1 - Publisher Copyright:
© Sheng-Hsuan Lin, Shih-Chen Fu, Chu-Lan Michael Kao. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 27.01.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - China
KW - COVID-19
KW - Mortality
KW - Mortality-prevalence ratio
KW - Prevalence
KW - Undocumented infection
UR - http://www.scopus.com/inward/record.url?scp=85100863470&partnerID=8YFLogxK
U2 - doi.org/10.2196/23034
DO - doi.org/10.2196/23034
M3 - Article
C2 - 33332282
AN - SCOPUS:85100863470
SN - 2369-2960
VL - 7
JO - JMIR Public Health and Surveillance
JF - JMIR Public Health and Surveillance
IS - 1
M1 - e23034
ER -
