Age-stratified infection fatality rate of COVID-19 in the non-elderly population

Angelo Maria Pezzullo; Cathrine Axfors; Despina G Contopoulos-Ioannidis; Alexandre Apostolatos; John P A Ioannidis

doi:10.1016/j.envres.2022.114655

Age-stratified infection fatality rate of COVID-19 in the non-elderly population

Environ Res. 2023 Jan 1;216(Pt 3):114655. doi: 10.1016/j.envres.2022.114655. Epub 2022 Oct 28.

Authors

Angelo Maria Pezzullo¹, Cathrine Axfors², Despina G Contopoulos-Ioannidis³, Alexandre Apostolatos⁴, John P A Ioannidis⁵

Affiliations

¹ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Sezione di Igiene, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
² Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
³ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
⁴ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Faculty of Medicine, Université de Montréal, Montreal, Canada.
⁵ Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, Stanford University, Stanford, CA, USA. Electronic address: jioannid@stanford.edu.

Abstract

The largest burden of COVID-19 is carried by the elderly, and persons living in nursing homes are particularly vulnerable. However, 94% of the global population is younger than 70 years and 86% is younger than 60 years. The objective of this study was to accurately estimate the infection fatality rate (IFR) of COVID-19 among non-elderly people in the absence of vaccination or prior infection. In systematic searches in SeroTracker and PubMed (protocol: https://osf.io/xvupr), we identified 40 eligible national seroprevalence studies covering 38 countries with pre-vaccination seroprevalence data. For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013-0.056%) for the 0-59 years old population, and 0.095% (IQR 0.036-0.119%) for the 0-69 years old. The median IFR was 0.0003% at 0-19 years, 0.002% at 20-29 years, 0.011% at 30-39 years, 0.035% at 40-49 years, 0.123% at 50-59 years, and 0.506% at 60-69 years. IFR increases approximately 4 times every 10 years. Including data from another 9 countries with imputed age distribution of COVID-19 deaths yielded median IFR of 0.025-0.032% for 0-59 years and 0.063-0.082% for 0-69 years. Meta-regression analyses also suggested global IFR of 0.03% and 0.07%, respectively in these age groups. The current analysis suggests a much lower pre-vaccination IFR in non-elderly populations than previously suggested. Large differences did exist between countries and may reflect differences in comorbidities and other factors. These estimates provide a baseline from which to fathom further IFR declines with the widespread use of vaccination, prior infections, and evolution of new variants.

Keywords: Bias; COVID-19; Epidemics; Infection fatality rate; Seroprevalence.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
COVID-19* / epidemiology
Child
Child, Preschool
Comorbidity
Humans
Infant
Infant, Newborn
Middle Aged
SARS-CoV-2
Seroepidemiologic Studies
Vaccination
Young Adult