Objective

To provide estimates of the relative rate of COVID-19 death in people <65 years old versus older individuals in the general population, the absolute risk of COVID-19 death at the population level during the first epidemic wave, and the proportion of COVID-19 deaths in non-elderly people without underlying diseases in epicenters of the pandemic.

Eligible data

Cross-sectional survey of countries and US states with at least 800 COVID-19 deaths as of April 24, 2020 and with information on the number of deaths in people with age <65. Data were available for 14 countries (Belgium, Canada, France, Germany, India, Ireland, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland, UK) and 13 US states (California, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania). We also examined available data on COVID-19 deaths in people with age <65 and no underlying diseases.

Main outcome measures

Proportion of COVID-19 deaths in people <65 years old; relative mortality rate of COVID-19 death in people <65 versus ≥65 years old; absolute risk of COVID-19 death in people <65 and in those ≥80 years old in the general population as of June 17, 2020; absolute COVID-19 mortality rate expressed as equivalent of mortality rate from driving a motor vehicle.

Results

Individuals with age <65 account for 4.5–11.2% of all COVID-19 deaths in European countries and Canada, 8.3–22.7% in the US locations, and were the majority in India and Mexico. People <65 years old had 30- to 100-fold lower risk of COVID-19 death than those ≥65 years old in 11 European countries and Canada, 16- to 52-fold lower risk in US locations, and less than 10-fold in India and Mexico. The absolute risk of COVID-19 death as of June 17, 2020 for people <65 years old in high-income countries ranged from 10 (Germany) to 349 per million (New Jersey) and it was 5 per million in India and 96 per million in Mexico. The absolute risk of COVID-19 death for people ≥80 years old ranged from 0.6 (Florida) to 17.5 per thousand (Connecticut). The COVID-19 mortality rate in people <65 years old during the period of fatalities from the epidemic was equivalent to the mortality rate from driving between 4 and 82 miles per day for 13 countries and 5 states, and was higher (equivalent to the mortality rate from driving 106–483 miles per day) for 8 other states and the UK. People <65 years old without underlying predisposing conditions accounted for only 0.7–3.6% of all COVID-19 deaths in France, Italy, Netherlands, Sweden, Georgia, and New York City and 17.7% in Mexico.

Conclusions

People <65 years old have very small risks of COVID-19 death even in pandemic epicenters and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.

中文翻译：

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总体而言，大流行人群中非老年人和没有基础疾病的非老年人的人群水平的COVID-19死亡率风险。

目的

为估算普通人群中65岁以下人群与老年人群中COVID-19死亡的相对发生率，第一次流行波期间人群水平上COVID-19死亡的绝对风险以及COVID-在大流行的中心地区有19例无基础疾病的非老年人死亡。

符合条件的数据

截至2020年4月24日，对至少有800例COVID-19死亡的国家和美国各州进行横断面调查，并提供有关65岁以下人群中死亡人数的信息。有14个国家（比利时，加拿大，法国，德国，印度，爱尔兰，意大利，墨西哥，荷兰，葡萄牙，西班牙，瑞典，瑞士，英国）和13个美国州（加利福尼亚州，康涅狄格州，佛罗里达州，乔治亚州，伊利诺伊州，印第安纳州，路易斯安那州，马里兰州，马萨诸塞州，密歇根州，新泽西州，纽约州，宾夕法尼亚州）。我们还检查了有关65岁以下且无基础疾病的人中COVID-19死亡的可用数据。

主要观察指标

65岁以下人群中COVID-19死亡比例；<65岁与65岁以上人群COVID-19死亡的相对死亡率；截至2020年6月17日，<65岁的人群和≥80岁的人群中COVID-19死亡的绝对风险；COVID-19绝对死亡率，表示为驾驶机动车所致的死亡率。

结果

在欧洲国家和加拿大，年龄小于65岁的个体占所有COVID-19死亡的4.5–11.2％，在美国地区占8.3–22.7％，在印度和墨西哥占多数。<65岁的人的COVID-19死亡风险比11个欧洲国家和加拿大的65岁以上的人低30至100倍，在美国地区的风险低16至52倍，而低于10倍在印度和墨西哥。截至2020年6月17日，高收入国家<65岁的人的COVID-19死亡的绝对风险为10（德国）至349 /百万（新泽西），印度为5 /百万，96为墨西哥百万。≥80岁的人的COVID-19死亡绝对风险为0.6（佛罗里达州）至17.5 /千（康涅狄格州）。人的COVID-19死亡率< 在13个国家和5个州，因流行病致死的65岁年龄段相当于每天驾驶4至82英里之间的死亡率，并且更高（相当于每天驾驶106-483英里所致的死亡率）用于其他8个州和英国。在法国，意大利，荷兰，瑞典，乔治亚州和纽约市，年龄<65岁且无潜在诱因的人仅占所有COVID-19死亡的0.7-3.6％，在墨西哥占17.7％。

结论

<65岁的人即使在大流行的震中也有很小的COVID-19死亡风险，<65岁的人如果没有潜在的诱因，则死亡的情况非常罕见。在应对大流行时，应考虑专门针对保护高危老年人的策略。