key: cord-0978872-qx1ez0gr
authors: Garcia‐Calavaro, Christian; Paternina‐Caicedo, Angel; Smith, Adrian D.; Harrison, Lee H.; De la Hoz‐Restrepo, Fernando; Acosta, Enrique; Riffe, Tim
title: COVID‐19 mortality needs age adjusting for international comparisons
date: 2021-04-23
journal: J Med Virol
DOI: 10.1002/jmv.27007
sha: aa8e1f2a7498afa225ba594dccc9f95662de9363
doc_id: 978872
cord_uid: qx1ez0gr

Covid-19 had caused more than 1,4 million deaths worldwide by November 26th, 2020. Age is a strong predictor of Covid-19 mortality. Crude death rates have been used to compare the response of countries, however, this measure does not account for age structure. We report age-adjusted mortality and rates at similar timeframes, ~100 days from the 50th confirmed case, for 51 countries, as well as 50 states in the US and the District of Columbia. We found age-adjusted mortality rate at ~ 100 days is 18 times greater in New Jersey (largest mortality in the U.S.), compared to Maine (lowest mortality in the U.S). Similar patterns were present in world countries. In Japan, the age-adjusted mortality rate was 0.1; while in Peru was 47.6 at ~ 100 days of Covid-19 transmission (476 times higher). Europe, Latin America, and the US, resulted in highest age-adjusted mortality rates worldwide during the first 100 days of transmission. The data suggest that measures taken by different territories might be a factor for the different mortality rates across regions and countries worldwide. Age-adjustments are needed to compare mortality between populations with different age-structures. This article is protected by copyright. All rights reserved.

19, with some studies showing a risk of death 120 times higher in the population older than 65 years. [3] [4] [5] Population age-structure varies widely between countries, with the percentage of the population ≥65 years old increasing with income, 6 while 18% of people in highincome countries are ≥65 years, in low-income countries this percentage is 3%. 6 Therefore, crude rates do not allow appropriate comparisons of mortality among countries with different agestructures. We compare mortality between 51 countries, as well as 50 states in the US and the District of Columbia that adopted different control strategies. We use data on deaths by 10-year age groups from COVerAGE-DB, 7 published and updated daily, population data from the United Nations, and the World Health Organization standard population for direct standardization by age. 8, 9 In addition, we report rates at similar timeframes (~100 days from the 50th confirmed case) to provide meaningful comparisons of community transmission.

In the US, the age-adjusted mortality rate at approximately 100 days is 16 times greater in the US state with the largest mortality (New Jersey), compared to the states with the lowest age-adjusted mortality rate (Alaska) (Figure 1 and Table S1 ). These patterns were present in different world countries, the age-adjusted mortality rate 

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