An ecological modeling on the adjusted effects of socioeconomic determinants and HLA-DRB1 alleles in fatality of COVID-19 during the early phase of epidemics in a group of countries.

INTRODUCTION Socioeconomic determinants along with genetic status may affect fatality rate of COVID-19. We intend to investigate the adjusted effects of the HLA-DRB1 alleles and socioeconomic determinants including gross domestic product per capita (GDP cap) and health expenditure per capita (HE cap) in fatality of COVID-19 during the early phase of epidemic in a group of countries. METHODS As an ecological study, early exposure to epidemics was defined as having more than 5000 confirmed cases of COVID-19 from 1 March 2020 to 1 April 2020. Poisson regression was used to report adjusted incidence rate ratio (IRR) for case fatality rate in this constant time period. RESULTS Fourteen countries were eligible. Among the alleles, DR7 showed the strongest risk factor (IRR=112.535, P<0.001). Having GDP cap more than 40000$ or having HE cap more than 3000$ was a protecting factor (IRR=0.899, P<0.001, adjusted with allele DR7). Having GDP cap more than 40000$ along with having HE cap more than 3000$ was a protecting factor (IRR=0.471, P<0.001, adjusted with allele DR7). CONCLUSION Socioeconomic status of the countries may compensate the probable harmful effect of some HLA-DRB1 alleles. This conclusion was limited to a period that all the selected countries had almost similar governmental intervention.