The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis

Ramy Abou Ghayda, Keum Hwa Lee, Young Joo Han, Seohyun Ryu, Sung Hwi Hong, Sojung Yoon, Gwang Hum Jeong, Jae Won Yang, Hyo Jeong Lee, Jinhee Lee, Jun Young Lee, Maria Effenberger, Michael Eisenhut, Andreas Kronbichler, Marco Solmi, Han Li, Louis Jacob, Ai Koyanagi, Joaquim Radua, Myung Bae ParkSevda Aghayeva, Mohamed L.C.B. Ahmed, Abdulwahed Al Serouri, Humaid O. Al-Shamsi, Mehrdad Amir-Behghadami, Oidov Baatarkhuu, Hyam Bashour, Anastasiia Bondarenko, Adrian Camacho-Ortiz, Franz Castro, Horace Cox, Hayk Davtyan, Kirk Douglas, Elena Dragioti, Shahul Ebrahim, Martina Ferioli, Harapan Harapan, Saad I. Mallah, Aamer Ikram, Shigeru Inoue, Slobodan Jankovic, Umesh Jayarajah, Milos Jesenak, Pramath Kakodkar, Yohannes Kebede, Meron Kifle, David Koh, Visnja K. Males, Katarzyna Kotfis, Sulaiman Lakoh, Lowell Ling, Jorge Llibre-Guerra, Masaki Machida, Richard Makurumidze, Mohammed A. Mamun, Izet Masic, Hoang Van Minh, Sergey Moiseev, Thomas Nadasdy, Chen Nahshon, Silvio A. Ñamendys-Silva, Blaise N. Yongsi, Henning B. Nielsen, Zita A. Nodjikouambaye, Ohnmar Ohnmar, Atte Oksanen, Oluwatomi Owopetu, Konstantinos Parperis, Gonzalo E. Perez, Krit Pongpirul, Marius Rademaker, Sandro Rosa, Ranjit Sah, Dina Sallam, Patrick Schober, Tanu Singhal, Silva Tafaj, Irene Torres, J. Smith Torres-Roman, Dimitrios Tsartsalis, Jadamba Tsolmon, Laziz Tuychiev, Batric Vukcevic, Guy Wanghi, Uwe Wollina, Ren He Xu, Lin Yang, Zoubida Zaidi, Lee Smith, Jae Il Shin

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The aim of this study is to provide a more accurate representation of COVID-19's case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

Original languageEnglish
Pages (from-to)2402-2413
Number of pages12
JournalJournal of Medical Virology
Issue number6
StatePublished - Jun 2022


  • COVID-19
  • case fatality rate
  • continents
  • proportion meta-analysis


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