Epidemiological and Clinical Characteristics of Non-Severe and Severe Pediatric and Adult COVID-19 Patients Across Different Geographical Regions: A Systematic Review and Meta-Analysis of Observational Studies

Background: An understanding of key differences in epidemiological and clinical characteristics between geographical regions and populations is limited. This systematic review and meta-analysis aims to compare clinical presentation, outcomes, and care management of different COVID-19 patient groups globally. Methods: The search strategy involved peer-reviewed studies published between 1st January and 9th April 2020 in Pubmed, Google scholar, and Chinese Medical Journal database. Pooled prevalence and means with 95% confidence intervals were computed using a random effects model. Subgroup analyses were performed between different geographies, clinical severities, and age groups. Results: A total of 77 publications were identified after full-text screening. Subsequently, data from 40 non-overlapping studies, comprising 4,884 patients from seven countries, were summarized. Wuhan patients were older (mean age: 54·3) and had higher rates of dyspnea (39·5%), compared to patients in other cities of China (mean age: 43·6; dyspnea: 9·7%) and outside of China (mean age: 50·5; dyspnea: 13·4%). Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent amongst Wuhan patients compared to other geographical subgroups (p<0·01). There was a significant dose-response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS from non-severe to severe and fatal outcomes (p<0·01). A higher proportion of asymptomatic cases in children (20%) as compared to adults (2.4%) was observed in Chinese hospitals. Interpretation: COVID-19 patients had more severe clinical disease in Wuhan compared to patients outside of Wuhan and beyond China. Pediatric cases had less severe disease compared to adults. Biomarkers at admission may be useful for prognosis among COVID-19 patients.Funding Statement: Ministry of Defence, SingaporeDeclaration of Interests: The authors declare no competing interests.