Basic Study
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World J Virol. Mar 25, 2024; 13(1): 87881
Published online Mar 25, 2024. doi: 10.5501/wjv.v13.i1.87881
Country-based modelling of COVID-19 case fatality rate: A multiple regression analysis
Soodeh Sagheb, Ali Gholamrezanezhad, Elizabeth Pavlovic, Mohsen Karami, Mina Fakhrzadegan
Soodeh Sagheb, Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA 98145, United States
Ali Gholamrezanezhad, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
Elizabeth Pavlovic, Department of Nursing, University of New Brunswick, New Brunswick E3B 5A3, Canada
Mohsen Karami, Mina Fakhrzadegan, Department of Orthopedics, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1516745811, Iran
Author contributions: Gholamrezanezhad A and Sagheb S conceived of the presented idea, and set the first draft of manuscript; Karami M and Pavlovic E developed the theory and worked out almost all of the technical details, and data extraction; Sagheb S and Fakhrzadegan M designed the model and the computational framework and analysed the data; language editing and revising the manuscript has done by Pavlovic E; All authors discussed the results and contributed to the final manuscript.
Institutional review board statement: In this modeling publicly available register-based ecological study as a population study, all data are available on open data sources like Our World in Data, World Bank, Statistics, OECD Database, and World Population Review. We included no private patients and no private data, and everything is clear in the references. As the research involves information freely available in the public domain, this study doesn't need to ethics code or institute approval.
Conflict-of-interest statement: All the authors have no financial relationships relevant to this article to disclose.
Data sharing statement: All study datasets are referenced and available to the public.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Gholamrezanezhad, MD, Associate Professor, Department of Radiology, Keck School of Medicine, University of Southern California, 3551 Trousdale Pkwy, University Park, Los Angeles, CA 90033, United States. ali.gholamrezanezhad@med.usc.edu
Received: August 31, 2023
Peer-review started: August 31, 2023
First decision: October 24, 2023
Revised: November 7, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: March 25, 2024
ARTICLE HIGHLIGHTS
Research background

The worldwide case fatality rate (CFR) of coronavirus disease 2019 (COVID-19) has been estimated to be around 1.5% as of now. Different variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus have been discovered to cause the disease. The clinical presentation of the disease ranges from asymptomatic status to upper respiratory tract symptoms, mild pneumonia, severe respiratory symptoms, acute respiratory distress syndrome, extrapulmonary manifestations, and death. Various risk factors for COVID-19 mortality including age, male gender, comorbidities (such as chronic kidney disease, cardiovascular disease, chronic obstructive pulmonary disease), diabetes mellitus, malignancy, underlying autoimmune disease, and hypertension), ethnicity, vaccination status, smoking history, obesity, and socioeconomic status. On the other hand, some factors have been proven to be protective, which may reduce the severity or mortality of COVID-19 infection, as among which vaccination, efficiently staffed facilities, particularly by registered nurses corticosteroid treatment, and healthy diet are the most notable. Gathering updated information from international data sources could throw light on the protective or potential risk factors to avoid COVID’s severe morbidities and mortality.

Research motivation

We find it interesting the topic trend analysis in the COVID-19 literature, and the success of modeling studies in the field of predicting disease behavior was a turning point for us.

Research objectives

The objective motivation for doing this study is to assess the correlation between different known risk factors or protective measures and the COVID-19 case fatality rate and we decided to design and conduct a new study based on modeling.

Research methods

Twenty-one potential risk factors were identified for COVID-19 case fatality rate for all the countries with available data. Univariate relationships of each variable with case fatality rate, and all independent variables to identify candidate variables for our final multiple model were examined. Finally multiple regression analysis technique was used to assess the strength of relationship between case fatality rate and several predictors’ variables as well as the importance of each predictor to the relationship.

Research results

There was a statistically significant inverse correlation between health expenditure, and number of computed tomography scanners per 1 million with case fatality rate, and a significant direct correlation was found between literacy, and air pollution with case fatality rate, this final model can predict approximately 97% of the changes in case fatality rate, conclusion: The current study recommends some new predictors explaining affect mortality rate. Thus, it could help decision-makers develop health policies to fight COVID-19.

Research conclusions

I suggest to do the same study with the updated data and compare the results. Multiple regression analysis technique is used as the most wrong and reliable method.

Research perspectives

Considering that global vaccination has been carried out, it is suggested that the approach of future realizations is to investigate the effectiveness of vaccines and compare the performance of vaccines with each other.