Role of Ascertainment Bias in Determining Case Fatality Rate of COVID-19
- 10.2991/jegh.k.210401.001How to use a DOI?
- Epidemiology; health policy; ascertainment bias; Global health; bias; epidemiologic methods; Africa; Asia; Europe; North America; South America; virus; COVID-19; SARS-COV-2; log-log linear regression; log slope
Case fatality rate (CFR) is used to calculate mortality burden of COVID-19 under different scenarios, thus informing risk-benefit balance of interventions both pharmaceutical and nonpharmaceutical. However, observed CFR is driven by testing: as more low-risk cases are identified, observed CFR will decline. This report quantifies test bias by modeling observed CFR as log-log-linear function of test density (tests per population) in 163 countries. CFR declined almost 20% (e.g. from 5% to 4%) for each doubling of test density (p < 0.0001); this association did not vary by continent (interaction p > 0.10) although at any given test density CFR was higher in Europe or North America than in Asia or Africa. This effect of test density on observed CFR is adequate to hide all but the largest true differences in case survivorship. Published estimates of CFR should specify test density, and comparisons should correct for it such as by applying the provided model.
- © 2021 The Author. Published by Atlantis Press International B.V.
- Open Access
- This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).
Cite this article
TY - JOUR AU - Maia P. Smith PY - 2021 DA - 2021/04/08 TI - Role of Ascertainment Bias in Determining Case Fatality Rate of COVID-19 JO - Journal of Epidemiology and Global Health SP - 143 EP - 145 VL - 11 IS - 2 SN - 2210-6014 UR - https://doi.org/10.2991/jegh.k.210401.001 DO - 10.2991/jegh.k.210401.001 ID - Smith2021 ER -