Document Type : Original Article


1 Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India

2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India

3 Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

4 Department of Community Medicine, KD Medical College, Mathura, Uttar Pradesh, India


BACKGROUND: 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.
MATERIALS AND METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.


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