Covid-19 mortality is associated with test number and government effectiveness

Objectives: A question central to the Covid-19 pandemic is why the Covid-19 mortality rate varies so greatly across countries. This study aims to investigate factors associated with cross-country variation in Covid-19 mortality. Methods: : Covid-19 mortality rate was calculated as number of deaths per 100 Covid-19 cases. To identify factors associated with Covid-19 mortality rate, a multivariable linear regression model was applied to a cross-sectional dataset comprising 78 countries and 1,790,550 patients infected by Covid-19. We retrieved data from the Worldometer website and the Worldwide Governance Indicators and World Development Indicators databases. Results: : Covid-19 mortality rate was negatively associated with Covid-19 test number per 1,000 population (RR=0.97; 95% CI 0.96 to 0.99, P=0.013) and government effectiveness indicator (RR=0.96; 95% CI 0.93 to 0.98, P=0.001). Covid-19 mortality rate was positively associated with number of critical cases per 100 Covid-19 cases, Covid-19 case number per 10,000 population, proportion of population aged 65 or older and proportion of deaths attributable to communicable diseases in previous years (all with P<0.05). Predicted mortality rates were highly associated with observed mortality rates (r = 0.74; P<0.001). Conclusions: : Multiple factors were associated with Covid-19 mortality rates. Increasing Covid-19 testing and improving government effectiveness may have the potential to attenuate Covid-19 mortality.Authors Li-Lin Liang and Chun-Ying Wu contributed equally to this work.