Pitfalls and solutions in case fatality risk estimation – A multi-country analysis on the role of demographics, surveillance, time lags between reporting and death and healthcare system capacity on COVID-19
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Abstract
European countries report large differences in COVID-19 case fatality risk (CFR) and high variation over the year. CFR estimates may both depend on the method used for estimation and of country-specific characteristics. While crude methods simply use cumulative total numbers of cases and deaths, the CFR can be influenced by the demographic characteristics of the cases, case detection rates, time lags between reporting of infections and deaths and infrastructural characteristics, such as healthcare capacities.
We used publicly available weekly data from the national health authorities of Germany, Italy, France and Spain on case and death numbers by age group connected to COVID-19 for the year 2020. We propose to use smoothed data of national weekly test rates for case adjustment and investigated the impact of different time lags from case reporting to death on the estimation of the CFR. Finally, we described the association between case fatality and the demand for hospital beds for COVID-19, taking into account national hospital bed capacities.
Crude CFR estimates differ considerably between the four study countries with end-of-year values of approximately 1.9%, 3.5%, 2.5% and 2.7% for Germany, Italy, France and Spain, respectively. Age-adjustment reduces the differences considerably, resulting in values of 1.61%, 2.4% and 2% for Germany, Italy and Spain, respectively. France’s age-specific data was restricted to hospitalised cases only and is therefore not comparable in that regard. International crude International CFR time series show smaller differences when adjusting for demographics of the cases or the test rates. Curves adjusted for age structure, testing or time lags show smaller variance over the year and a smaller degree of non-stationarity. The data does not suggest any connection of CFRs to hospital capacities for the four countries under study.
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SciScore for 10.1101/2020.05.16.20104117: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:As an important limitation of our work, we found that public data on the age structure of infected and deceased were missing in public reports on COVID-19 in many European countries. Even for the included countries, this data was partly only available at specific time points, for roughly aggregated age groups, or only for a selection of …
SciScore for 10.1101/2020.05.16.20104117: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:As an important limitation of our work, we found that public data on the age structure of infected and deceased were missing in public reports on COVID-19 in many European countries. Even for the included countries, this data was partly only available at specific time points, for roughly aggregated age groups, or only for a selection of all reported cases or deaths. For other countries, age-specific data are not openly available at all. Another limitation of this work is that we were not able to gain information on the distribution of comorbidities relevant to COVID-19 over age groups of infected and deceased in the European countries assessed, thus limiting our understanding of differences in CFR estimates due to differences in comorbidities. For the analysis of the association between fatality and the healthcare load measured by intensive care beds needed, we could not incorporate the age structure or severity of hospitalized cases into our computations, because these data were not available. Additionally, we did not have access to daily numbers of intensive care beds available for COVID-19 patients, which is why we chose to retain the absolute values of intensive care beds needed. For publicly available data to have public health consequences, better reporting of data on healthcare capacities on a daily or at least weekly scale is needed in Europe. More detailed data on the demographics of the cases and deaths would help our understanding of the demographic impact on the C...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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