Higher coronavirus disease-19 mortality linked to comorbidities: A comparison between low-middle income and high-income countries

Har Ashish Jindal; Soumya Swaroop Sahoo; Limalemla Jamir; Ashwini Kedar; Sugandhi Sharma; Bhumika Bhatt

doi:10.4103/jehp.jehp_142_21

Higher coronavirus disease-19 mortality linked to comorbidities: A comparison between low-middle income and high-income countries

J Educ Health Promot. 2021 Oct 29:10:377. doi: 10.4103/jehp.jehp_142_21. eCollection 2021.

Authors

Har Ashish Jindal¹, Soumya Swaroop Sahoo², Limalemla Jamir³, Ashwini Kedar¹, Sugandhi Sharma⁴, Bhumika Bhatt⁵

Affiliations

¹ Senior Consulatant, Ministry of Health and Family Welfare, New Delhi, India.
² Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India.
³ Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India.
⁴ Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁵ Department of Community Medicine, KD Medical College, Mathura, Uttar Pradesh, India.

Abstract

Background: Global burden of disease (GBD) provides the estimates of mortality and morbidity, while case fatality rate (CFR) helps in understanding the severity of the disease. People infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) with underlying medical conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the association of SARS-CoV-2 CFR with disability-adjusted life years (DALY) of various comorbidities in the low-middle income countries (LMIC) and high-income countries (HIC) to study the relationship of coronavirus disease-19 (COVID-19) mortality with GBDs and to understand the linkage between COVID-19 mortality and comorbidities.

Materials and methods: This was an ecological study with secondary data analysis comparing the DALY of various morbidities from GBD with CFR of COVID-19. Gross domestic product was the basis of stratifying 177 countries into low-middle income (LMIC) and high-income groups (HIC). The mortality was analyzed using Pearson correlation and linear regression.

Results: The median global CFR of SARS-CoV-2 was 2.15. The median CFR among LMIC (n = 60) and HIC (n = 117) was 2.01 (0.00-28.20) and 2.29 (0.00-17.26), respectively. The regression analysis found that, in both LMIC and HIC, maternal disorders were associated with higher SARS-CoV-2 CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while respiratory disorders were associated with lower CFR.

Conclusions: SARS-CoV-2 infection appears to be a systemic disease. Individuals with comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and nutritional deficiencies, have poorer outcomes with COVID-19, leading to higher mortality.

Keywords: Communicable disease; corona virus disease-19; global disease burden; morbidity; mortality; noncommunicable disease; severe acute respiratory syndrome coronavirus 2.