Higher coronavirus disease‑19 mortality linked to comorbidities: A comparison between low‑middle income and high‑income countries

Global burden of disease (GBD) provides the estimates of mortality and morbidity, while case fatality rate (CFR) helps in understanding the severity of the disease. People infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV‑2) with underlying medical conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the association of SARS‑CoV‑2 CFR with disability‑adjusted life years (DALY) of various comorbidities in the low‑middle income countries (LMIC) and high‑income countries (HIC) to study the relationship of coronavirus disease‑19 (COVID‑19) mortality with GBDs and to understand the linkage between COVID‑19 mortality and comorbidities.

This was an ecological study with secondary data analysis comparing the DALY of various morbidities from GBD with CFR of COVID‑19. Gross domestic product was the basis of stratifying 177 countries into low‑middle income (LMIC) and high‑income groups (HIC). The mortality was analyzed using Pearson correlation and linear regression.

The median global CFR of SARS‑CoV‑2 was 2.15. The median CFR among LMIC (n = 60) and HIC (n = 117) was 2.01 (0.00–28.20) and 2.29 (0.00–17.26), respectively. The regression analysis found that, in both LMIC and HIC, maternal disorders were associated with higher SARS‑CoV‑2 CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while respiratory disorders were associated with lower CFR.

SARS‑CoV‑2 infection appears to be a systemic disease. Individuals with comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and nutritional deficiencies, have poorer outcomes with COVID‑19, leading to higher mortality.