Demystifying the varying case fatality rates (CFR) of COVID-19 in India: Lessons learned and future directions

  • Edwin Sam Asirvatham Health Systems Research India Initiative (HSRII), Trivandrum, India
  • Jeyaseelan Lakshmanan Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
  • Charishma Jones Sarman Independent Public Health Consultant, New Delhi, India
  • Melvin Joy Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
Keywords: COVID-19, Case Fatality Rate, CFR, fractional regression, predictors

Abstract

Introduction: At the end of the second week of June 2020, the SARS-CoV-2 responsible for COVID-19 infected above 7.5 million people and killed over 400,000 worldwide. Estimation of case fatality rate (CFR) and determining the associated factors are critical for developing targeted interventions.

Methodology: The state-level adjusted case fatality rate (aCFR) was estimated by dividing the cumulative number of deaths on a given day by the cumulative number confirmed cases 8 days before, which is the average time-lag between diagnosis and death. We conducted fractional regression analysis to determine the predictors of aCFR.

Results: As of 13 June 2020, India reported 225 COVID-19 cases per million population (95% CI:224-226); 6.48 deaths per million population (95% CI:6.34-6.61) and an aCFR of 3.88% (95% CI:3.81-3.97) with wide variation between states. High proportion of urban population and population above 60 years were significantly associated with increased aCFR (p=0.08, p=0.05), whereas, high literacy rate and high proportion of women were associated with reduced aCFR (p<0.001, p=0.03). The higher number of cases per million population (p=0.001), prevalence of diabetes and hypertension (p=0.012), cardiovascular diseases (p=0.05), and any cancer (p<0.001) were significantly associated with increased aCFR. The performance of state health systems and proportion of public health expenditure were not associated with aCFR.

Conclusions: Socio-demographic factors and burden of non-communicable diseases (NCDs) were found to be the predictors of aCFR. Focused strategies that would ensure early identification, testing and effective targeting of non-literate, elderly, urban population and people with comorbidities are critical to control the pandemic and fatalities.

Published
2020-10-31
How to Cite
1.
Asirvatham ES, Lakshmanan J, Sarman CJ, Joy M (2020) Demystifying the varying case fatality rates (CFR) of COVID-19 in India: Lessons learned and future directions. J Infect Dev Ctries 14:1128-1135. doi: 10.3855/jidc.13340
Section
Coronavirus Pandemic