Association between excess mortality due to COVID-19, full vaccination coverage, smoking, hypertension, and gross domestic product per capita/purchasing power parity across 10 Southeast Asian Countries

Abstract

Objectives

Mass vaccination and cardiometabolic disorders have been reported to influence COVID-19 prognosis and mortality burden. We applied a generalized linear mixed model (GLMM) to explore the associations between COVID-19 mortality, full vaccination coverage, and cardiometabolic health indicators in Southeast Asia (SEAR).

Methods

A region-wide ecological analysis of aggregate COVID-19 data from 10 SEAR countries (January 2020 to December 2022) was performed. The databases used were from the John Hopkins University Coronavirus Resource Center and the WHO Health Organization. Excess deaths associated with COVID-19 per 100,000 and case fatality rate were the outcome variables. A GLMM was performed to determine the predictors of COVID-19 mortality, and adjustments were made for sociodemographic variables. The statistical significance level was set at P <0.01 (double-sided).

Results

The adjusted GLMM analysis showed that the number of excess deaths due to COVID-19 per 100,000 was strongly and positively associated with age-standardized smoking (coefficient of determination [coeff.] = 9.18 [standard error (SE): 2.15]; P <0.001) and hypertension prevalence (coeff. = 25.98 [SE: 9.15]; P <0.01), whereas it was strongly and negatively associated with the full vaccination coverage rate (coeff. = −5.23 [SE: 1.54]; P <0.01) and gross domestic product per capita/purchasing power parity (coeff. = −102.01 [SE: 18.31]; P <0.001). The COVID-19 case fatality rate was positively associated with the age-standardized prevalence of hypertension (coeff. = 0.30 [SE: 0.16]; P <0.01) and negatively correlated with the full vaccination coverage rate (coeff. = −0.05 [SE: 0.01]; P <0.01) and gross domestic product per capita/purchasing power parity (coeff. = −1.09 (SE: 0.34); p<0.001). The associations observed in the multivariate analysis remained in the stratified analysis by quartile.

Conclusions

The study findings suggest that implementing effective public health interventions that would have increased vaccine uptake and improve cardiometabolic health on one hand and initiatives that enhance country-level economy on the other hand would have reduced COVID-19 mortality in the SEAR.