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As of 1 November 2020, estimated case-fatality rates associated with coronavirus disease 2019 are not uniformly patterned across the world and differ substantially in magnitude. Given the global spatial heterogeneity in case-fatality rates, we applied the Blinder-Oaxaca regression decomposition technique to identify how putative sociodemographic, structural, and environmental sources influence variation in case-fatality rates. We show that compositional and associational differences in country-level risk factors explain a substantial proportion of the coronavirus disease 2019-related case-fatality rate gap across nations. Asian countries fair better vis-à-vis case-fatality rate differences mainly due to variation in returns to sociodemographic, structural, and environmental sources among their citizens, relative to those who share similar attributes but live in Europe or North America. The variation in case-fatality rate is driven by Asian populations being better able to buffer the harmful effects of the very risk factors purported to exacerbate the risk of coronavirus disease 2019-related death. The dire circumstances in which we find ourselves demand better understanding of how preexisting conditions across countries contribute to observed disparities in case-fatality rates.


This is an Accepted Manuscript of an article published in Pathogens and Global Health in 2020, available online at It may differ slightly from the final version of record.

The publisher has made the final version freely available to read for a time, due to its relation to the ongoing COVID-19 pandemic at the time of publication.

This scholarship is part of the Chapman University COVID-19 Archives.

Peer Reviewed



Taylor & Francis


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