Older age groups and country-specific case fatality rates of COVID-19 in Europe, USA and Canada

Infection. 2021 Feb;49(1):111-116. doi: 10.1007/s15010-020-01538-w. Epub 2020 Oct 24.


Purpose: To evaluate the association between the percentages of older age groups among confirmed SARS-CoV-2 infections and the country-specific case fatality rate (CFR).

Methods: This ecological study analyzed data from the 20 most severely affected European countries, USA and Canada, in which national health authorities provided data on age distribution and gender among confirmed SARS-CoV-2 cases and deaths.

Results: The proportion of individuals older than 70 years among confirmed SARS-CoV-2 cases differed markedly between the countries, ranging from 4.9 to 40.4%. There was a strong linear association between the proportion of individuals older than 75 years and the country-specific CFRs (R2 = 0.803 for all countries, R2 = 0.961 after exclusion of three countries with incongruent data). Each 5% point increase of this older age group among confirmed SARS-CoV-2 cases was associated with an increase in CFR of 2.5% points (95% CI 1.9-3.1).

Conclusion: Data from 20 European countries and the USA and Canada showed that the variance of crude CFR of COVID-19 is predominantly (80-96%) determined by the proportion of older individuals who are diagnosed with SARS-CoV-2. The age distribution of SARS-CoV-2 infections is still far from being homogeneous. Detailed demographic data have to be taken into account in all the analyses on COVID-19-associated mortality. We urgently call for standardized data collection by national health authorities.

Keywords: Age distribution; COVID-19; Case fatality rate; SARS-CoV-2.

MeSH terms

  • Age Distribution
  • Age Factors
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • COVID-19 / mortality*
  • COVID-19 / pathology
  • COVID-19 / virology
  • Canada / epidemiology
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics*
  • SARS-CoV-2 / pathogenicity
  • Survival Analysis
  • United States / epidemiology