Document Type : Original Article


Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran


BACKGROUND: The COVID‑19 pandemic has spread rapidly across the world and has currently
impacted most countries and territories globally. This study aimed to identify health‑care determinants
of mortality and recovery rates of COVID‑19 and compare the efficiency of health systems in response
to this pandemic.
MATERIALS AND METHODS: A cross‑sectional study was conducted using data obtained from the
World Bank database, that provides free and open access to a comprehensive set of health‑ and
socioeconomic‑related data, by September 12, 2020. An adjusted linear regression model was
applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1
MP) in the included countries. One‑way analysis of variance was applied to assess health systems’
efficiency in response to COVID‑19 pandemic using mortality and recovery rate (output variables)
and current health expenditure (CHE) per capita (input variable).
RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed
case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1
MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries
with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and
population aged 65 years and over as a percentage of total population (SC = −0.79, P < 0.001)
significantly predicted recovered cases from COVID‑19 in the included countries.
CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of
older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore,
our study indicated that health systems with higher CHE per capita statistically had a greater efficiency
in response to COVID‑19 compared to those with lower CHE per capita. More attention to preventive
strategies, early detection, and early intervention is suggested to improve the health system efficiency
in controlling COVID‑19 and its related mortalities worldwide.


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