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We found multiple ecological studies investigating the association between country-level factors (eg, population-level burden of comorbidities, socioeconomic factors, environmental factors, and containment policies) and mortality rates from COVID-19.
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We did not restrict this search by language or type of publication. We first included the Medical Subject Heading (MeSH) “COVID-19” and the MeSH Major Topic “Global Health/statistics and numerical data”. We searched PubMed for articles published from date of database inception to Nov 1, 2021, exploring the association between country-level policies and socioeconomic resources and COVID-19 outcomes in people with rheumatic disease. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1♲% p=0♱4). Number of hospital beds (0♹4 per 1-unit increase per 1000 people p=0♰46), human development index (0♶5 per 0♱-unit increase p=0♰32), government response stringency (0♸3 per 10-unit increase in containment index p=0♰018), as well as follow-up time (0♷8 per month p<0♰001) were independently associated with lower odds of mortality. Air pollution (odds ratio 1♱0 per 10 μg/m 3 p=0♰105), proportion of the population aged 65 years or older (1♱9 per 1% increase p<0♰001), and population mobility (1♰3 per 1% increase in number of visits to grocery and pharmacy stores p<0♰001 and 1♰2 per 1% increase in number of visits to workplaces p=0♰32) were independently associated with higher odds of mortality. The Lancet Regional Health – Western Pacificġ4 044 patients from 23 countries were included in the analyses.The Lancet Regional Health – Southeast Asia.The Lancet Gastroenterology & Hepatology.