Investigating the effect of macro-scale estimators on worldwide COVID-19 occurrence and mortality through regression analysis using online country-based data sources

Sabri Erdem; Fulya Ipek; Aybars Bars; Volkan Genç; Esra Erpek; Shabnam Mohammadi; Anıl Altınata; Servet Akar

doi:10.1136/bmjopen-2021-055562

Investigating the effect of macro-scale estimators on worldwide COVID-19 occurrence and mortality through regression analysis using online country-based data sources

BMJ Open. 2022 Feb 14;12(2):e055562. doi: 10.1136/bmjopen-2021-055562.

Authors

Sabri Erdem¹, Fulya Ipek², Aybars Bars³, Volkan Genç³, Esra Erpek⁴, Shabnam Mohammadi³, Anıl Altınata³, Servet Akar⁴

Affiliations

¹ Department of Business Administration, Dokuz Eylül University, Izmir, Turkey.
² Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey fulya.ipek@hacettepe.edu.tr.
³ Social Sciences Institute, Dokuz Eylül University, Izmir, Turkey.
⁴ Department of Internal Medicine, Division of Rheumatology Atatürk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.

Abstract

Objective: To investigate macro-scale estimators of the variations in COVID-19 cases and deaths among countries.

Design: Epidemiological study.

Setting: Country-based data from publicly available online databases of international organisations.

Participants: The study involved 170 countries/territories, each of which had complete COVID-19 and tuberculosis data, as well as specific health-related estimators (obesity, hypertension, diabetes and hypercholesterolaemia).

Primary and secondary outcome measures: The worldwide heterogeneity of the total number of COVID-19 cases and deaths per million on 31 December 2020 was analysed by 17 macro-scale estimators around the health-related, socioeconomic, climatic and political factors. In 139 of 170 nations, the best subsets regression was used to investigate all potential models of COVID-19 variations among countries. A multiple linear regression analysis was conducted to explore the predictive capacity of these variables. The same analysis was applied to the number of deaths per hundred thousand due to tuberculosis, a quite different infectious disease, to validate and control the differences with the proposed models for COVID-19.

Results: In the model for the COVID-19 cases (R²=0.45), obesity (β=0.460), hypertension (β=0.214), sunshine (β=-0.157) and transparency (β=0.147); whereas in the model for COVID-19 deaths (R²=0.41), obesity (β=0.279), hypertension (β=0.285), alcohol consumption (β=0.173) and urbanisation (β=0.204) were significant factors (p<0.05). Unlike COVID-19, the tuberculosis model contained significant indicators like obesity, undernourishment, air pollution, age, schooling, democracy and Gini Inequality Index.

Conclusions: This study recommends the new predictors explaining the global variability of COVID-19. Thus, it might assist policymakers in developing health policies and social strategies to deal with COVID-19.

Trial registration number: ClinicalTrials.gov Registry (NCT04486508).

Keywords: COVID-19; health policy; public health.

MeSH terms

COVID-19*
Health Policy
Humans
Information Storage and Retrieval
Regression Analysis
SARS-CoV-2

Associated data

ClinicalTrials.gov/NCT04486508