Comparing COVID-19 fatality across countries: a synthetic demographic indicator

Background The case fatality rate (CFR) is one of the most important measures for monitoring disease progression and evaluating appropriate policy health measures over the course of the COVID-19 pandemic. To remove biases arising from the age structure of COVID-19 cases in international comparisons of the CFR, existing studies have relied mainly on direct standardisation. Objective We propose and validate a synthetic indicator of COVID-19 fatality (SCFR) that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases without relying on the arbitrary choice of a standard population. Results Contrary to what comparisons of the crude CFR suggest, differences in COVID-19 fatality across countries according to the proposed SCFR are not very stark. Importantly, once we adjust for the age structure of COVID-19 cases, the higher case fatality among men emerges as the main driver of international differences in COVID-19 CFR. Conclusions The SCFR is a simple indicator that is useful for monitoring the fatality of SARS-CoV-2 mutations and the efficacy of health policy measures for COVID-19, including vaccination. Contributions (1) A simple synthetic indicator of COVID-19 fatality that improves its comparability across countries by adjusting for the age and sex structure of COVID-19 cases; (2) Evidence that sex differences in COVID-19 fatality drive international differences in the overall CFR.