Document Type : Original Article


1 Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden

2 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

3 Department of Education and Research, Emergency Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran

4 Department of Nursing, School of Nursing and Emergency, Dezful University of Medical Sciences, Dezful, Iran

5 Department of Nurse Sciences, Faculty of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran

6 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Department of Education and Research, Emergency Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran


BACKGROUND: The first case of COVID‑19 was reported in Iran on February 19, 2020, in Qom. Since
Mazandaran is one of the high‑risk provinces with many patients and deaths, this study was conducted
to investigate the epidemiological characteristics of COVID‑19‑related deaths in Mazandaran.
MATERIALS AND METHODS: In this descriptive study, demographic information and clinical
findings in patients who died following COVID‑19 in the medical centers of Mazandaran University of
Medical Sciences from February 8, 2020, to October 10, 2020, were extracted. Data were analyzed
by using SPSS 21. Logistic regression was used to compare the data. P < 0.05 was considered as
the significance level.
RESULTS: Out of a total of 34,039 patients admitted during the 8 months, 2907 patients died. Of
these, 1529 (52%) were male, and the rest were female. In terms of age, 10 cases in the age group
of fewer than 15 years, 229 cases in the age group of 15–44 years, 864 patients in the age group of
45–64 years, and 1793 people in the age group of 65 years and over died. 2206 people (more than
75%) by personal visit referred to medical centers. The mortality rate was more than 8 cases per 100
hospitalized patients. Men were 16% more likely to die from COVID‑19 than women.
DISCUSSION AND CONCLUSION: Older adults over 65 have the highest incidence and death rate
due to this disease. The incidence rate was higher in women, and the death rate was higher in men,
which differs from the national pattern.


  1. Zhan C, Tse CK, Fu Y, Lai Z, Zhang H. Modeling and prediction
    of the 2019 coronavirus disease spreading in China incorporating
    human migration data. medRxiv 2020 Oct 27 [cited 2021 Nov
    13];15(10):e0241171. Available from:
    content/10.1101/2020.02.18.20024570v1.abstract. [Last accessed
    on 2021 Jan 22].
    2. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of
    unknown etiology in Wuhan, China: The mystery and the miracle.
    J Med Virol 2020;92:401‑2.
    3. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and
    outcomes of critically ill patients with SARS‑CoV‑2 pneumonia
    in Wuhan, China: A single‑centered, retrospective, observational
    study. Lancet Respir Med 2020;8:475‑81.
    4. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical
    characteristics of coronavirus disease 2019 in China. N Engl J Med
    5. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the
    potential domestic and international spread of the 2019‑nCoV
    outbreak originating in Wuhan, China: A modeling study. Obstet
    Gynecol Surv 2020;75:399‑400.
    6. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features
    of patients infected with 2019 novel coronavirus in Wuhan, China.
    Lancet 2020;395:497‑506.
    7. Data [Internet]. Vol. Publish Ah, JWeekly Epidemiological Update
    Data. 2020 [cited 2021 Jan 21]. Available from: https://www.who.
    8. Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan,
    China. Glob Health Res Policy 2020;5:6.
    9. Irani M, Pakfetrat A, Mask MK. Novel coronavirus disease 2019
    and perinatal outcomes. Educ Health Promot 2020;9:1‑5.
    10. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD,
    Fouchier RA. Isolation of a novel coronavirus from a man with
    pneumonia in Saudi Arabia. N Engl J Med 2012;367:1814‑20.
    11. Wang C, Horby PW, Hayden FG, Gao GF. Novel coronavirus
    outbreak of global health concern. Lancet 2020;395:470‑3.
    12. Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed
    asymptomatic carrier transmission of COVID‑19. J Am Med Assoc
    13. GorbalenyaA, Baker S, BaricR, de GrootR, Drosten C, GulyaevaA,
    et al. Severe acute respiratory syndrome‑related coronavirus : The
    species and its viruses – A statement of the Coronavirus Study
    Group. Nat Microbiol 2020 Apr 2 [cited 2021 Nov 13];5:536-44.
    Available from:
    . [Last accessed on 2021 Jan 22].
    14. Peng PW, Ho PL, Hota SS. Outbreak of a new coronavirus: What
    anaesthetists should know. Br J Anaesth 2020;124:497‑501.
    15. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of
    SARS‑CoV‑2 in different types of clinical specimens. J Am Med
    Assoc 2020;323:1843‑4.
    16. ZangrilloA, BerettaL. PS‑CC and, 2020 Undefined. Critical Care and
    Resuscitation – Fast Reshaping of Intensive Care Unit Facilities in a
    Large Metropolitan Hospital in Milan, Italy: Facing the COVID‑19
    Pandemic Emergency (Health Collection) – Informit. Available
    dn=196484700544171;res=IELHEA. [Last accessed on 2021 Jan 22].
    17. Remuzzi A, Remuzzi G. COVID‑19 and Italy: What next? Lancet
    18. Ahmadi A, Fadaei Y, Shirani M, Rahmani F. Modeling and
    forecasting trend of COVID‑19 epidemic in Iran until May 13,
    2020. Med J Islam Repub Iran 2020;34:27.
    19. Meskarpour‑Amiri M, Shams L, Nasiri T. Identifying and
    categorizing the dimensions of Iran’s health system response to
    the COVID‑19 pandemic. Mil Med 2020;22:108‑14.
    20. Omidi M, Maher A, Etesaminia S. Lessons to be learned from
    the prevalence of COVID‑19 in Iran. Med J Islam Repub Iran
    21. BikdeliB, TalasazAH, RashidiF, Sharif‑KashaniB, FarrokhpourM,
    Bakhshandeh H, et al. Intermediate versus standard‑dose
    prophylactic anticoagulation and statin therapy versus placebo
    in critically‑ill patients with COVID‑19: Rationale and design
    of the INSPIRATION/INSPIRATION‑S studies. Thromb Res
    22. Farahahni AJ, Ebrahimnia M, Zijoud SR. Non‑governmental and
    voluntary groups, collaborators in the fight against COVID‑19.
    Mil Med 2020;22:98‑9.
    23. Repici A, Maselli R, Colombo M, Gabbiadini R, Spadaccini M,
    Anderloni A, et al. Coronavirus (COVID‑19) outbreak: What the
    department of endoscopy should know. Gastrointest Endosc
    24. Cookson B. Regarding “Understanding the emerging coronavirus:
    What it means to health security and infection prevention.” J
    Clean Prod 2020 Aug [cited 2021 Nov 13];105(4):792. Available
    S0195‑6701 (20)30099‑2/abstract. [Last accessed on 2021 Jan 22].
    25. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging
    2019 novel coronavirus (2019‑nCoV) pneumonia. Radiology
    26. Health Ministry. COVID 19 Epidemiology Committee; 2020.
    Available from: [Last accessed
    on 2021 Jan 22].
    27. Ziarati M, Mohammad S, Zorriehzahra J, Dadar M, Hassantabar
    F, Seidgar M, et al. 2020 Undefined. Perspective on the Origin
    of COVID‑19 and Its Epidemic Situation in Iran and the World.
    Available from: and
    sid=1 and slc_lang=en and ftxt=1. [Last accessed on 2021 Jan 22].
    28. Heydari ST, Zarei L, Sadati AK, Moradi N, Akbari M,
    Mehralian G, et al. The effect of risk communication on preventive
    and protective Behaviours during the COVID‑19 outbreak:
    Mediating role of risk perception. BMC Public Health 2021;21:54.
    29. BazarganM, Med MA‑JM, 2020 Undefined. Geographical Analysis
    of COVID‑19 Epidemiology in Iran with Exploratory Spatial Data
    Analysis Approach (ESDA). Available from: http://militarymedj.
    ir/article‑1‑2502‑en.htmlDO. [Last accessed on 2021 Jan 22].
    30. Nikpouraghdam M,… AF‑J of C, 2020 Undefined.
  2. Epidemiological Characteristics of Coronavirus Disease
    2019 (COVID‑19) Patients in IRAN: A Single Center Study.
    Available from:
    /PMC7172806/. [Last accessed on 2021 Jan 22].
    31. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis
    of coronavirus disease (COVID‑19) outbreak. Autoimmun
    2020;109:1-5(4). Available from:
    32. Jee Y. WHO International Health Regulations Emergency
    Committee for the COVID‑19 outbreak. Epidemiol Health
    33. Park SE. Epidemiology, virology, and clinical features of severe
    acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2;
    coronavirus disease‑19). Pediatr Infect Vaccine 2020;27:1‑10.
    34. Bajgain KT, Badal S, Bajgain BB, Santana MJ. Prevalence of
    comorbidities among individuals with COVID‑19: A rapid review
    of current literature. Am J Infect Control 2021;49:238‑46.
    35. Singh AK, Gillies CL, Singh R, Singh A, Chudasama Y, Coles B,
    et al. Prevalence of comorbidities and their association with
    mortality in patients with COVID-19: A systematic review and
    meta-analysis. Diabetes Obes Metab 2020;22:1915‑24.
    36. Kazemi‑KaryaniA, Safari‑FaramaniR, AminiS, Ramezani‑DorohV,
    Berenjian F, Dizaj M, et al. World one‑hundred days after
    COVID‑19 outbreak: Incidence, case fatality rate, and trend. Educ
    Health Promot 2020;9:199.