COVID-19 Mortality in Europe, by Latitude and Obesity Status: A Geo-Spatial Analysis in 40 Countries

Abstract

On 30 January 2020, the World Health Organization (WHO) declared the current novel coronavirus disease 2019 (COVID-19) as a public health emergency of international concern and later characterized it as a pandemic. New data show that excess body mass and vitamin D deficiency might be related to the disease severity and mortality. The aim of this study was to evaluate whether latitude, as a proxy of sunlight exposure and Vitamin D synthesis, and prevalent obesity among European populations, is related to COVID-19 spread and severity. European COVID-19 data (incidence and fatality), including information on the prevalence of obesity, social distancing, and others were obtained by the "Our World in Data" website on 17 April 2021. Adjusted analysis showed that higher COVID-19 incidence and fatality were pictured in countries being in higher latitude, both during the whole period, as well as, during the time period 1 November 2020-31 March 2021. Higher incidence and fatality of COVID-19 were observed where the prevalence of overweight/obesity was higher during the whole time period, whereas during the time period 1 November 2020-31 March 2021, only COVID-19 incidence was higher but not a fatality. The present results provide insights for targeted interventions and preventive strategies against COVID-19.

Keywords: COVID-19; Vitamin D synthesis; fatality; incidence; obesity; sunlight exposure.

Figure 1

Spatial variability of the COVID-19 (A) incidence and (B) fatality during the time period 1 January 2020–17 April 2021.

Figure 2

Results from Poisson regression analysis regarding the relationship of the prevalence of overweight/obesity with the incidence and fatality of COVID-19 per 1 million population during the whole time period (1 January 2020–17 April 2021) and during the time period 1 November 2020–31 March 2021; Notes: Results are presented in the form: IRR (95% CI); IRR: Incidence Rate Ratio; CI: Confidence Interval; IRRs are presented per 1% increment in the prevalence of overweight/obesity, and they are adjusted for the median population’s age, the stringency index, the population density and the GDP per capita; Stringency Index: A composite measure based on nine response indicators including school closures, workplace closures, and travel bans, rescaled to a value from 0 to 100 (100 = strictest).