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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2020 Asirvatham et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.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.
Author(s): Asirvatham ES, Lakshmanan J, Sarman CJ, Joy M
Publication type: Article
Publication status: Published
Journal: Journal of Infection in Developing Countries
Year: 2020
Volume: 14
Issue: 10
Pages: 1128-1135
Online publication date: 31/10/2020
Acceptance date: 02/04/2018
Date deposited: 28/07/2023
ISSN (print): 2036-6590
ISSN (electronic): 1972-2680
Publisher: Journal of Infection in Developing Countries
URL: https://doi.org/10.3855/jidc.13340
DOI: 10.3855/jidc.13340
PubMed id: 33175707
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