Country-level Association of Socioeconomic, Environmental and Healthcare-Related Factors with the Disease-Burden and Mortality Rate of COVID-19

Background: COVID-19 pandemic is rapidly expanding throughout the world right now. Caused by a novel strain of the coronavirus, the manifestation of this pandemic shows a unique level of disease burden and mortality rate in different countries. Objective: In this paper, we investigated the effects of several socioeconomic, environmental, and healthcare-related factors on the disease burden and mortality rate of COIVID-19 across countries. Our main objective is to provide a macro-level understanding of the most influential socioeconomic, environmental, and healthcare-related factors associated with the disease burden and mortality rate metrics without human bias. Methods: We developed a multiple linear regression model using backward elimination to find the best fitting between reported death and cases across countries for country-level aggregated independent factors keeping COVID-19 test statistics in consideration. Notably, the method requires minimum human intervention and handles confounding effects intrinsically. Results: Our results show that while the COVID-19 pandemic is seemingly spreading more rapidly in economically affluent countries, it Is more deadly in countries with inadequate healthcare infrastructure, lower capacity of handling epidemics, and lower allocation of the healthcare budget. We also did not find evidence of any association between environmental factors and COVID-19. Conclusion: We took the number of tests performed into account and normalized the case and mortality counts based on the cumulative distribution of cases across days. Our analysis of the standardized factors provides both the direction and relative importance of different factors leading to several compelling insights into the most influential socioeconomic and healthcare infrastructure-related factors from a country-level view.