Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality
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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DOI：
10.1371/journal.pone.0238904
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发表时间：
2020-09-10
期刊：
影响因子：
3.7
通讯作者：
Myrskyla, Mikko
中科院分区：
文献类型：
--
作者：
Dudel, Christian;Riffe, Tim;Myrskyla, Mikko
与COVID-19相关的人口水平病死率（CFR）在任何特定时间的国家之间以及随着时间的推移在国家内部都存在很大差异。我们分析了观察到的CFR变化的两个关键决定因素的贡献：诊断感染病例的年龄结构和年龄特异性病死率。我们使用了中国、德国、意大利、韩国、西班牙、美国和纽约市按年龄划分的确诊COVID-19病例和归因于COVID-19的死亡人数的数据。我们计算了每个人群在最新数据点的CFR，以及意大利、德国、西班牙和纽约市随时间的CFR。我们使用人口统计学分解将CFR之间的差异分解为确诊病例的年龄结构和特定年龄的病死率所产生的独特贡献。于二零二零年六月下旬，现金流量比率由韩国的2. 2%至意大利的14. 0%不等。发现病例的年龄结构通常可以解释CFR中三分之二以上的跨国变异。在意大利，2020年3月9日至6月30日期间，病死率从4.2%上升至14.0%，超过90%的变化是由于年龄特异性病死率上升。确诊病例的年龄结构的重要性可能反映了几个因素，包括不同的检测制度和传播轨迹的差异;而意大利年龄特异性病例死亡率的增加可能表明其他因素，例如感染COVID-19的人的健康状况恶化。我们的研究结果支持按年龄和潜在的其他变量分列数据的建议，以促进更好地了解CFRs的人口水平差异。它们还表明，需要进行精心设计的血清阳性率研究，以确定检测制度的差异在多大程度上导致检出病例的年龄结构差异。
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.