Association of Country-wide Coronavirus Mortality with Demographics, Testing, Lockdowns, and Public Wearing of Masks

Am J Trop Med Hyg. 2020 Dec;103(6):2400-2411. doi: 10.4269/ajtmh.20-1015. Epub 2020 Oct 26.

Abstract

We studied sources of variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Potential predictors of per-capita coronavirus-related mortality in 200 countries by May 9, 2020 were examined, including age, gender, obesity prevalence, temperature, urbanization, smoking, duration of the outbreak, lockdowns, viral testing, contact-tracing policies, and public mask-wearing norms and policies. Multivariable linear regression analysis was performed. In univariate analysis, the prevalence of smoking, per-capita gross domestic product, urbanization, and colder average country temperature were positively associated with coronavirus-related mortality. In a multivariable analysis of 196 countries, the duration of the outbreak in the country, and the proportion of the population aged 60 years or older were positively associated with per-capita mortality, whereas duration of mask-wearing by the public was negatively associated with mortality (all P < 0.001). Obesity and less stringent international travel restrictions were independently associated with mortality in a model which controlled for testing policy. Viral testing policies and levels were not associated with mortality. Internal lockdown was associated with a nonsignificant 2.4% reduction in mortality each week (P = 0.83). The association of contact-tracing policy with mortality was not statistically significant (P = 0.06). In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 16.2% each week, as compared with 61.9% each week in remaining countries. Societal norms and government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.

MeSH terms

  • Age Factors
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / mortality*
  • COVID-19 Testing / methods
  • Cold Temperature
  • Comorbidity
  • Contact Tracing / legislation & jurisprudence
  • Global Health / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Linear Models
  • Masks / supply & distribution*
  • Multivariate Analysis
  • Obesity
  • Pandemics*
  • Physical Distancing
  • Quarantine / organization & administration*
  • SARS-CoV-2 / pathogenicity*
  • Severity of Illness Index
  • Sex Factors
  • Smoking / physiopathology
  • Survival Analysis
  • Urbanization