The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis

Abstract

The aim of this study is to provide a more accurate representation of COVID-19's case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

Keywords: COVID-19; case fatality rate; continents; proportion meta-analysis.

Figure 1

Timeline of variables among countries with COVID‐19 reported as of October 30, 2020: (A) No. of patients, (B) pooled‐estimated CFR, (C) fixed‐estimated CFR, and (D) random‐estimated CFR. fixed: fixed‐effect model, random: random‐effect model, and pooled: calculated CFR based on incidence and mortality data. CFR, case fatality rate; COVID‐19, coronavirus 2019; NA, North America; No., number; SA, South America

Figure 2

Timeline of variables classified grade of income among countries with COVID‐19 reported as of October 30, 2020: (A) No. of patients, (B) pooled‐estimated CFR, (C) fixed‐estimated CFR, and (D) random‐estimated CFR. Fixed: fixed‐effect model, random: random‐effect model, and pooled: calculated CFR based on incidence and mortality data. CFR, case fatality rate; COVID‐19, coronavirus 2019; HI, high income; LI, low income; MI, middle income; No., number

Figure 3

Timeline of CFR according to calendar date (reported as of October 30, 2020) in: (A) the whole world, (B) Asia, (C) Europe, (D) North America, (E) South America, (F) Africa, and (G) Oceania. Fixed: fixed‐effect model, random: random‐effect model, and pooled: calculated CFR based on incidence and mortality data. CFR, case fatality rate; No., number

Figure 4

Timeline of CFR according to calendar date (reported as of October 30, 2020) in: (A) high‐income countries, (B) middle‐income countries, and (C) low‐income countries. Fixed: fixed‐effect model, random: random‐effect model, and pooled: calculated CFR based on incidence and mortality data. CFR, case fatality rate; No., number