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.