Correlation study to identify the factors affecting COVID-19 case fatality rates in India

BACKGROUND AND AIMS: In India, COVID-19 case fatality rates (CFRs) have consistently been very high in states like Punjab and Maharashtra and very low in Kerala and Assam. To investigate the discrepancy in state-wise CFRs, datasets on various factors related to demography, socio-economy, public health, and healthcare capacity have been collected to study their association with CFR. METHODS: State-wise COVID-19 data was collected till April 22, 2021. The latest data on the various factors have been collected from reliable sources. Pearson correlation, two-tailed P test, Spearman rank correlation, and Artificial Neural Network (ANN) structures have been used to assess the association between various factors and CFR. RESULTS: Life expectancies, prevalence of overweight, COVID-19 test positive rates, and H1N1 fatality rates show a significant positive association with CFR. Human Development Index, per capita GDP, public affairs index, health expenditure per capita, availability of govt. doctors & hospital beds, prevalence of certain diseases, and comorbidities like diabetes and hypertension show insignificant association with CFR. Sex ratio, health expenditure as a percent of GSDP, and availability of govt. hospitals show a significant negative correlation with CFR. CONCLUSION: The study indicates that older people, males of younger age groups, and overweight people are at more fatality risk from COVID-19. Certain diseases and common comorbidities like diabetes and hypertension do not seem to have any significant effect on CFR. States with better COVID-19 testing rates, health expenditure, and healthcare capacity seem to perform better with regard to COVID-19 fatality rates.