Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications
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Abstract
Determine age-specific infection fatality rates for COVID-19 to inform public health policies and communications that help protect vulnerable age groups. Studies of COVID-19 prevalence were collected by conducting an online search of published articles, preprints, and government reports that were publicly disseminated prior to 18 September 2020. The systematic review encompassed 113 studies, of which 27 studies (covering 34 geographical locations) satisfied the inclusion criteria and were included in the meta-analysis. Age-specific IFRs were computed using the prevalence data in conjunction with reported fatalities 4 weeks after the midpoint date of the study, reflecting typical lags in fatalities and reporting. Meta-regression procedures in Stata were used to analyze the infection fatality rate (IFR) by age. Our analysis finds a exponential relationship between age and IFR for COVID-19. The estimated age-specific IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85. Moreover, our results indicate that about 90% of the variation in population IFR across geographical locations reflects differences in the age composition of the population and the extent to which relatively vulnerable age groups were exposed to the virus. These results indicate that COVID-19 is hazardous not only for the elderly but also for middle-aged adults, for whom the infection fatality rate is two orders of magnitude greater than the annualized risk of a fatal automobile accident and far more dangerous than seasonal influenza. Moreover, the overall IFR for COVID-19 should not be viewed as a fixed parameter but as intrinsically linked to the age-specific pattern of infections. Consequently, public health measures to mitigate infections in older adults could substantially decrease total deaths.
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From Immunological mechanisms of vaccine-induced protection against COVID-19 in humans (2021) · cites this paper as [29]
Death rates from COVID-19 tend to be higher among males than females, with higher case-fatality rates among older age groups.
“Death rates from COVID-19 tend to be higher among males than females, with higher case-fatality rates among older age groups”
From Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries (2022) · cites this paper as [17]
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INFERRED RESOLUTION THROUGH HERD IMMMUNITY OF FIRST COVID-19 WAVE IN MANAUS, BRAZILIAN AMAZONPreprint
Prowse, T. A. A., Purcell, T., Baía-da-Silva, D. C., Sampaio, V. D. S., Monteiro, W. M., Wood, J., Müeller, I., McVernon, J., Lacerda, M., & Ross, J. V. (2020) · medRxiv · doi:10.1101/2020.09.25.20201939 · Cited by 10 · see citing works
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SARS-CoV-2 antibody seroprevalence in patients receiving dialysis in the USA
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Risk Factors for COVID-19: Community Exposure and Mask-WearingPreprint
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- Authors
- Levin, A. T., Hanage, W. P., Owusu-Boaitey, N., Cochran, K. B., Walsh, S. P., & Meyerowitz-Katz, G.
- Affiliations
- Dartmouth College (US)
- Harvard University (US)
- Venue
- European Journal of Epidemiology
- Published
- 2020-12
- Volume
- 35
- Issue
- 12
- Pages
- 1123-1138
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- PMC
- PMC7721859
- OpenAlex
- W3111021405
- Cited by
- 844
- References
- 92
- Citations by year
- 2026: 31 · 2025: 52 · 2024: 76 · 2023: 125 · 2022: 261 · 2021: 264 · 2020: 34 · 2019: 1
- FWCI
- 6.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Epidemiology (publishedVersion, cc-by)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, infection fatality rate, age-specific mortality, age structure, older adults, middle-aged adults, children, public health policy, seasonal influenza
- MeSH terms
- COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Cause of Death, Female, Humans, Male, Middle Aged, Mortality, Predictive Value of Tests, Public Policy, Severity of Illness Index, Models, Statistical, Young Adult, Pandemics
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