DOI: 10.7910/dvn/ylv8ik
title: Replication Data for: Pre-pandemic scores of epidemiologic and demographic parameters highly correlate with Covid-19 death mortality in Western Europe and North Africa

description: Pre-pandemic scores of epidemiologic and demographic parameters highly correlate with Covid-19 death mortality in Western Europe and North Africa Mourad ERRASFA* *Department of Pharmacology, Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco. Email: mourad.er-rasfa@usmba.ac.ma Abstract On the first anniversary of the Covid19 pandemic, thousands of deaths were registered around the world, however, some countries suffered more than others in incidence and mortality caused by the SARS-CoV-2 coronavirus. In the present work we have sought the pre-academic epidemiologic and demographic parameters (2019) of several countries of Western Europe and North Africa. Large differences of covid19 mortality were observed between European and African countries. The results of our analyses show a positive correlation between some parameters (cancer, Alzheimer's disease, advanced age) and Covid-19 mortality. On the other hand, there was a negative correlation between some demographic parameters (annual birth rate, mortality and fertility rate) and Covid-19 mortality. We also found a strong positive correlation between the annual rate of alcohol consumption in each country and Covid-19 mortality. A first order linear equation linking (Birth Rate / Mortality Rate) to Covid-19 mortality in the 11 countries of this study predicted Covid-19 mortality of two Spanish cities (Ceuta and Melilla) in North Africa. We developed an equation that expresses a risk score; called Epidemiologic and Demographic Risk Factor (EDRF), which is expressed as a ratio between (Positively correlated) and (negatively correlate) parameters to Covid-19. Our results prove that a country's EDRF may play a key role in the severity of its Covid-19. Alcohol consumption, cancer and Alzheimer disease scores may be the most relevant causes of Covid-19 severity. Keywords: Covid-19, Coronavirus, SARS-CoV-2, epidemiology, demography, birth rate, fertility rate, alcohol intake. Introduction Since the Covid-19 pandemic was declared early 2020, there have been a significant number of publications on SARS-CoV-2) and Covid-19 pathophysiology (1). SARS-Cov-2-infected people can experience mild to moderate symptoms, such as muscle pain, headaches, loss of smell and taste, diarrhea, and more severe symptoms such as difficulty to breathing, which may endanger the life of the patient if the treatment is not properly configured. In the absence of a specific antiviral against SARS-Cov-2, the treatment of patients has often been prophylactic, directed against infections, inflammatory conditions (cytokine storm) and microcoagulations. Vitamins (C, D, B) and mineral salts (magnesium, selenium, zinc) have also been prescribed as support therapy, as well as probiotics (1). After one year of pandemic, it was possible to make an evaluation of certain epidemiological and demographic data of the pre-pandemic phase and check their usefulness in Covid-19 mortality. Several Western European countries (United Kingdom, Germany, France, Italy, Spain, Portugal) have registered high Covid-19 mortality rates compared to some neighboring countries in North Africa (Morocco, Algeria, Libya, Tunisia, Mauritania). The purpose of this study was the analysis of possible factors that could explain such differences in Covid-19 mortalities (2). Materials and Methods: We obtained Covid-19 data, epidemiologic and demographic trends from specialized websites for population and health statistics (3-8). The data and figures were processed and analyzed (Mean, standard deviation, comparison of groups by the Student test and the Pearson correlation test) by the Microsoft Office Excel program (2007). All epidemiologic and demographic data analyzed in the present study were of 2019. Alcohol consumption data are from a survey of 2016 (8). Cancer score was estimated as the number of cancers reported in the table of ten most cause of death published by the IMHE and WHO (2,3). Alzheimer disease score was estimated as " 11 minus the ranking order of Alzheimer disease among 10 cause of death of each country. When Alzheimer disease was not listed, the score was "0". Advanced age score was considered as the % of people aged 65 years and above. Alcohol intake score was considered as the annual rate of alcohol consumption per capita (9). An Epidemiologic and Demographic Risk Factor (EDRF) for Covid-19 was calculated as follows: EDRF= (Cancer score + Alzheimer score) + advanced age score / (Birth Rate / Mortality Rate) + Fertility rate. Results and Discussion In this study, six Western European countries (Great Britain, Germany, France, Italy, Spain, Portugal) and five North African countries (Morocco, Algeria, Tunisia, Libya, Mauritania) were included. Their demographic data are shown in Tale 1. Differences in the demographic parameters (birth rate, fertility rate, birth rate / mortality rate ratio and log of (% people aged 65 and above) and alcohol consumption are very significant between Western European and North African countries as shown in Table 2. As a key parameter of Covid-19 incidence, we considered the cumulative number of deaths of each country during the first year of the pandemic (March 1st, 2020 to March 22, 2021). The mortality curves of Western European countries as well as those of North African countries showed some parallelism from the beginning of the pandemic. There was a first phase (first wave) of four months (March, April, May, June 2020) with a peak at mid-April. We can consider that there has been a second phase that extended from mid-August to March 22, 2021, where the majority of deaths in the first year of the Covid-19 pandemic occurred. Figure 1 shows the annual mortality rate for 2019 in each country of the present study (Figure 1 left panel) and the mortality rate caused by Covid-19 (Figure 1 right panel). The figure shows a higher 2019 annual mortality in Western European countries compared to North African countries. Covid-19 mortality in Western European countries was significantly higher than in North African countries. Birth and fertility rates were significantly lower in Western European countries compared to the countries of North Africa (Figure 2, Left and Right panel). Both birth rate and mortality rate were positively correlated to Covid-19 mortality (Figure 3, Left and Right panel). The (birth rate-to-death rate) ratio in Western European countries was also very low in Western European countries compared to North African countries (Figure4 Left panel). (Birth Rate / Mortality Rate) ratio was highly correlated to Covid-19 mortality (Figure 4, Right panel). The Covid-19 mortality was higher in elderly and nursing homes of several European countries. Thus, advanced age was considered as a risk factor for Covid-19 (9). The percentage of people aged 65 and above was higher in Western European countries compared to North African countries (Figure 5), and it was highly correlated to Covid-19 mortality. According to epidemiologic data published by IHME and WHO (2,3), the list of the 10 most causes of death in Western European countries are quite similar and correspond to the profile of high income countries. Most chronic diseases are shared (heart failure, stroke, chronic obstructive pulmonary disease, hypertension, diabetes and renal insufficiency) by both European and North African countries, nevertheless, the ranking of each disease differs from a country to another. Instead, two main disease conditions; Cancer and Alzheimer disease, are described as serious risk factors for Covid-19. Hence, we have selected the above two pathologies to analyze their relationship to Covid-19 incidence in our study. Figure 6 (left panel) shows that cancer score was much higher in Western European countries in 2019 compared to North African countries, mainly in the UK (scores 5) and France (scores 4). Cancer score was correlated to Covid-19 deaths (Figure 6, right panel). Similarly, the incidence of Alzheimer’s disease has been very high in Western Europe compared to North African countries (Figure 7, left panel). Its score was correlated to Covid-19 mortality (Figure , right panel7). These results confirm the importance of cancer pathologies and Alzheimer’s disease in the high scores of Covid-19 mortality in Western Europe. Figure 8 shows that the Epidemiology and Demography Risk Factor (EDRF) is very high in Western European countries compared to North Africa countries. A high Pearson correlation (R= +0.891) was found between EDRF and Covid-19 mortality. This data confirms that EDRF might have endangered the outcome of Covid-19 patients in European countries, which could explain their very high scores of Covid-19 mortality. A 2016 survey of Alcohol consumption showed high scores in the Western European countries compared to African countries. We found that alcohol consumption was highly correlated to Covid-19 mortality (Figure 9) and to cancer scores (data not shown). Ceuta and Melilla are two Spanish cities located in the north of Morocco whose populations are 50% of North African ethnicity and they have many Moroccan nutritional and social habits. Both cities have had low Covid-19 mortality compared to the rest of the main land Spanish cities. We have calculated their estimated Covid-19 deaths using four differents equations that links demographic parameters to Covid-19 deaths (Table 2). All qeuations gave estimated numbers of deaths very close to the registered Covid-19 death numbers of both Ceuta and Melilla. In figure 11, we have plotted the % of people of 65 years old and above vs Covid-19 death numbers of the eleven countries of this study and have included the registered Covid-19 deaths of the cities of Ceuta and Melilla. We obtain a first order linear equation with a high Pearson's factor of correlation, and the result is in accordance with the calculated Covid-19 deaths of the above cities in table 3. This result show that the equations used in table 3 have good estimation of Covid-19 deaths number on one hand, on the other hand, demographic data of Ceuta and Melilla look rather more like the Moroccan than the Spanish demographic data, and that may be explained by similarities of ethnic, social and nutrition factors of the populations of Morocco, Ceuta and Melilla. In this study, EDRF is found to be a key factor in the prediction of Covid-19 outcome in a given country. Its components are key epidemiologic and demographic factors in the health status of the population. EDRF represents an "iceberg" of a whole immune capacity status of an individual who might face chronic or infectious diseases. EDRF might be influenced by several parameters, such as genetic, nutritional, social and cultural habits of a population. The above parameters may modulate immune status and the cellular and molecular constitution of an individual that make him more or less vulnerable to SARS-CoV-2 infection. In light of the results of the present study, unless bad surprises happen with SARS-Cov-2 variants, populations of North Africa could consider relaxing their safety measures in order to recover a better social and economic activities, while Western European countries should take serious safety measures before all population at risk get vaccinated. Conflicts of interest: None Funding: The presenting work did not receive any funding. References: 1- Mourad Errasfa. Blood Hemostasis Dysfunction and Inflammation in COVID-19 Patients: Viral and Host Active Molecules as Therapeutic Targets. The Open Toxicology Journal, 2021, 7: 1-7. 2- Covid-19 data in motion. https://coronavirus.jhu.edu/us-map 3- Causes of Death. http://www.healthdata.org 4- The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death 5https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/home.htm 6- https://www.ine.es/ 7- Natalité, mortalité, mortalité infantile. https://www.ined.fr/fr/tout-savoir-population/chiffres/europe-pays-developpes/natalite-mortalite-mortalite-infantile/ 8- Natalité et fécondité dans l'Union européenne. https://www.insee.fr/fr/statistiques/2381396#tableau-figure1 9- Hannah Ritchie and Max Roser (2018) - "Alcohol Consumption". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/alcohol-consumption 10- Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis [published correction appears in Lancet Infect Dis. 2020 Apr 15;:] [published correction appears in Lancet Infect Dis. 2020 May 4;:]. Lancet Infect Dis. 2020;20(6):669-677. doi:10.1016/S1473-3099(20)30243-7