Document Type : Original Article
Authors
- . Rahmatollah Moradzadeh
- . Seyed Mohammad Jamalian 1
- . Javad Nazari 2
- . Alireza Kamali 3
- . Bahman Sadeghi 4
- . Zahra Hosseinkhani 5
- . Masoomeh Sofian 6
- . Maryam Zamanian
1 Department of Forensic Medicine and Poisoning, Arak University of Medical Sciences, Arak, Iran
2 Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran
3 Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
4 Department of Social Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran
5 Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
6 Infectious Disease Research Center, Arak University of Medical Sciences, Arak, Iran
Abstract
BACKGROUND: To have a thorough understanding of epidemic surveillance, it is essential to broaden
our knowledge of death tolls worldwide. This study aimed to determine the age‑standardized mortality
rate (ASMR) and predictors of mortality among coronavirus disease 2019 (COVID‑19) patients.
MATERIALS AND METHODS: In this cross‑sectional design, all COVID‑19 patients with a
positive polymerase chain reaction test in the population covered by Arak University of Medical
Sciences (AUMS) were entered to the study. Data collection was conducted by phone interview.
The study variables comprised age, sex, coronary heart diseases, diabetes, and some symptoms
at admission. The adjusted odds ratio (OR) and 95% confidence intervals (CIs) were obtained by
logistic regression. The direct method was applied to calculate ASMR (per 100,000) of COVID‑19.
The analysis was applied by STATA software 12.0.
RESULTS: A total of 208 cases of COVID‑19 (out of 3050 total infected cases) were dead and
2500 cases were recovered. The mean age of dead patients was 70 years. The COVID‑19 fatality
rate in the population equaled 6.8%; in those patients who were 70 years old or more, however, the
case fatality rate was 16.4%. The ASMR of COVID‑19 was 12.9 (CI 95%: 11.2, 14.8). The odds of
COVID‑19‑related death in the age over 60 were 10.87 (CI 95%: 6.30, 18.75) times than lower 45 years
old. Moreover, it was observed that COVID‑19 significantly increased the odds of COVID‑19‑related
death in diabetes patients (OR = 1.45, CI 95%: 1.02, 2.06, P = 0.036).
CONCLUSION: The ASMR of COVID‑19 was relatively higher in males than females. In general, the
COVID‑19 fatality rate was relatively high. We found that older age and diabetes can have impact
on the death of COVID‑19, but the headache was found to have a negative association with the
COVID‑19‑related death.
Keywords
Flores JP, et al. Incidence, clinical outcomes, and transmission
dynamics of severe coronavirus disease 2019 in California and
Washington: Prospective cohort study. BMJ 2020;369:m1923.
2. Moradzadeh R. The challenges and considerations of
community‑based preparedness at the onset of COVID‑19
outbreak in Iran, 2020. Epidemiol Infect 2020;148:e82.
3. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al‑Jabir A,
et al. World Health Organization declares global emergency:
A review of the 2019 novel coronavirus (COVID‑19). Int J Surg
2020;76:71‑6.
4. Technical Reports of World Health Organization; 25 May, 2020.
Available from: https://www.who.int/docs/default‑source/
coronaviruse/situation‑reports/20200524‑covid‑19‑sitrep‑125.
pdf?sfvrsn=80e7d7f0_2. [Last accessed on 2020 Nov 29].
5. Rao C. Medical certification of cause of death for COVID‑19. Bull
World Health Organ 2020;98:298‑298A.
6. Moradzadeh R, Anoushirvani AA. Trend of gastric cancer
incidence in an area located in the Center of Iran: 2009‑2014.
J Gastrointest Cancer 2020;51:159‑64.
7. Health Emergencies Preparedness and Response, WHO Global.
Diagnostic Testing for SARS‑CoV‑2, Interim Guidance 11 September
2020. WHO REFERENCE NUMBER: WHO/2019‑nCoV/
laboratory/; 2020. p. 6. Available from: https://www.who.int/
publications/i/item/diagnostic‑testing‑for‑sars‑cov‑2. [Last
accessed on 2020 Sep 17].
8. McGahan CE, Linn K, Guno P, Johnson H, Coldman AJ, Spinelli JJ,
et al. Cancer in first nations people living in British Columbia,
Canada: An analysis of incidence and survival from 1993 to 2010.
Cancer Causes Control 2017;28:1105‑16.
9. Consonni D, Coviello E, Buzzoni C, Mensi C. A command to
calculate age‑standardized rates with efficient interval estimation.
Stata J 2012;12:688‑701.
10. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for
severity and mortality in adult COVID‑19 inpatients in Wuhan.
J Allergy Clin Immunol 2020;146:110‑118.
11. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course
and risk factors for mortality of adult inpatients with COVID‑19
in Wuhan, China: A retrospective cohort study. Lancet
2020;395:1054‑62.
12. Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al.
Predictors of mortality for patients with COVID‑19 pneumonia
caused by SARS‑CoV‑2: A prospective cohort study. Europ Resp
J 2020;55:2000524.
13. Wu X, Nethery RC, Sabath BM, Braun D, Dominici F. Exposure
to air pollution and COVID‑19 mortality in the United States:
A nationwide cross‑sectional study. Sci Adv 2020;6:abd4049
14. Ji Y, Ma Z, Peppelenbosch MP, Pan Q. Potential association
between COVID‑19 mortality and health‑care resource
availability. Lancet Glob Health 2020;8:e480.
15. Jordan RE, Adab P, Cheng KK. Covid‑19: Risk factors for severe
disease and death. BMJ 2020;368:m1198.
16. Kazemi-Karyani A, Safari-Faramani R, Amini S, Ramezani-Doroh
V, Berenjian F, Dizaj MY, Hashempour R, Dizaj JY. World onehundred days after COVID-19 outbreak: Incidence, case fatality
rate, and trend. J Educ Health Promot 2020;9:1-10.
17. World Health Organization Team. Department of Communications,
Global Infectious Hazard Preparedness, WHO Global. Estimating
mortality from COVID‑19. WHO REFERENCE NUMBER:
WHO‑2019‑nCoV‑Sci_Brief‑Mortality‑2020. COVID‑19: Scientific Briefs;
1 August, 2020. Available from: https://www.who.int/publications/i/
item/WHO‑2019‑nCoV‑Sci‑Brief‑Mortality‑2020.1. [Last accessed on
2020 Sep 18].
18. Bhopal SS, BhopalR. Sex differential in COVID‑19 mortality varies
markedly by age. Lancet 2020;396:532‑3.
19. Kadel S, Kovats S. Sex hormones regulate innate immune cells
and promote sex differences in respiratory virus infection. Front
Immunol 2018;9:1653.
20. Michelozzi P, de’Donato F, Scortichini M, de Sario M, Noccioli F,
RossiP, et al. Mortality impacts of the coronavirus disease (COVID‑19)
outbreak by sex and age: Rapid mortality surveillance system, Italy,
1 February to 18 April 2020. Euro Surveill 2020;25:1‑5.
21. Mojtaba S, Maryam T, Yousef A, Sima A, Hadiseh H. Factors
associated with mortality in COVID‑19 patients: A systematic
review and meta‑analysis. Iran J Public Health 2020;49: 1211–1221.
22. Odegaard JI, Chawla A. Connecting type 1 and type 2 diabetes
through innate immunity. Cold Spring Harb Perspect Med
2012;2:a007724.
23. Guo L, Wei D, ZhangX, WuY, Li Q, Zhou M, et al. Clinical features
predicting mortality risk in patients with viral pneumonia: The
MuLBSTA score. Front Microbiol 2019;10:2752.
24. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for
patients with diabetes in times of COVID‑19 epidemic. Diabetes
Metab Syndr 2020;14:211‑2.
25. Moradzadeh R, Mansournia MA, Baghfalaki T, Nadrian H,
Gustafson P, McCandless LC. The impact of maternal smoking
during pregnancy on childhood asthma: Adjusted for exposure
misclassification; results from the National Health and Nutrition
Examination Survey, 2011‑2012. Ann Epidemiol 2018;28:697‑703.
26. Moradzadeh R, Mansournia MA, Ghiasvand R, Baghfalaki T,
NadrianH, Holakouie‑NaieniK. Impact of age at menarche on breast
cancer: The assessment of recall Bias. Arch Iran Med 2019;22:65‑70.
27. Koolivand A, Amini S. The importance of PHC-based measures
in controlling COVID-19 outbreak: implications for global health
system. Ethics, Med. Public Health 2020;14: 1-3.
28. Nazari J, Amini S, Amiresmaili M. Lessons learned to control
COVID-19 to prevent a crisis: the case of Iran. Open Publ Health
J 2020;13:1-2.