Healthcare Indicators of Death Rate for COVID-19 in the European Union

Along with identification of clinical or laboratory predictors of unfavorable progression of coronavirus disease 2019 (COVID-19), it is also vital to recognize environmental and hospital indicators that may drive successful management of this illness, thus explaining the heterogeneity of death rates observed across different countries. We retrieved the date of the first diagnosed case and the crude death rate for COVID-19 for each of the European Union (EU) countries from the website of the John Hopkins University, which were then combined with environmental, hospital and clinical indicators extracted from the European Health Information Gateway of the World Health Organization. The COVID-19 death rate in EU countries (mean value 1.9±0.8%) was inversely associated with number of available general hospitals, physicians and nurses. Significant positive associations were also found with rate of acute care beds occupancy, as well as with rate of population aged over 65 years, overweight, and with cancer. Neither total health care expenditure, public-sector health expenditure, or the number of hospital and acute care beds influenced the death rate for COVID-19. These results suggest that some common healthcare system inadequacies such as low number of general hospitals, physicians and nurses, along with high acute care beds occupancy, may be significant drivers of nationwide COVID-19 mortality rates in EU countries.