@article{3034726,
    title = "Comparative Analysis of Mortality From Coronavirus Disease 2019 Across
the European Union Countries and the Effects of Vaccine Coverage",
    author = "Ziakas, Panayiotis D. and Kourbeti, Irene S. and Mylonakis, Eleftherios",
    journal = "Open Forum Infectious Diseases",
    year = "2022",
    volume = "9",
    number = "3",
    publisher = "OXFORD UNIV PRESS INC",
    issn = "2328-8957",
    doi = "10.1093/ofid/ofac006",
    keywords = "coronavirus; COVID-19; Europe; location quotient; mortality; SARS-CoV-2;
vaccine",
    abstract = "Background Mortality is a critical measure of disease impact. The
European Union (EU) countries share the same regulatory framework but
different implementation policies. Methods We extracted cumulative
COVID-19 mortality data across the EU countries. We evaluated the 27
member states using the location quotient (LQ) to adjust for the
expected mortality in the whole EU region, where an LQ 1 a less
favorable outcome. We categorized EU members into 3 distinct profiles
based on their LQ estimates: favorable profile, LQ <= 0.9; unfavorable
profile, LQ >1.10; and average profile, LQ between 0.9 and 1.10. We
compared LQ estimates and profiles with the prevaccination era that
ended in December 2020 with the COVID-19 vaccine rollout. Results Twelve
member states had a favorable profile, 4 had an average profile, and 11
had an unfavorable profile. In quantitative analysis, an improvement
(negative LQ difference) was noted across countries with higher
vaccination coverage (median, 71% fully vaccinated vs 57% for
countries with positive LQ differences). There was a significant
negative association between the share of fully vaccinated and LQ
changes (rho = -0.62, P < .001) and a significant 4-month lag effect.
After COVID-19 vaccines became available, 4 countries improved their
profile and 5 moved to a worse profile. Conclusions There is significant
variability in mortality and impact of COVID-19 between countries, even
if they share the same regulatory framework. Extending immunization
coverage may lead the transition to a more favorable profile, and alter
the trajectory of COVID-19 mortality."
}