@article{fdi:010078816,
  title = {{COVID}-19 : spatial analysis of hospital case-fatality rate in {F}rance},
  author = {{S}ouris, {M}arc and {G}onzalez, {J}.{P}.},
  editor = {},
  language = {{ENG}},
  abstract = {{W}hen the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. {T}he objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan {F}rance during the inception of the {COVID}-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate ({CFR}) between {F}rench districts. {I}n theory, the hospital age-standardized {CFR} should not display significant differences between districts, since hospital lethality depends on the virulence of the pathogen (the {SARS}-{C}o{V}-2 virus), the vulnerability of the population (mainly age-related), the healthcare system quality, and cases and deaths definition and the recording accuracy. {W}e analyzed hospital data on {COVID}-19 hospitalizations, severity (admission to intensive care units for reanimation or endotracheal intubation) and mortality, from {M}arch 19 to {M}ay 8 corresponding to the first {F}rench lockdown. {A}ll rates were age-standardized to eliminate differences in districts age structure. {T}he results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity. {T}ime analysis shows that the case-fatality rate has decreased over time, globally and in almost all districts, showing an improvement in the management of severe patients during the epidemic. {I}n conclusion, it appears that during the first critical phase of {COVID}-19 ramping epidemic in metropolitan {F}rance, the higher case-fatality rates were generally related to the higher level of hospitalization, then potentially related to the overload of healthcare system. {A}lso, low hospitalization with high case-fatality rates were mostly found in districts with low population density, and could due to some limitation of the local healthcare access. {H}owever, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate, and this variation is small compared to much greater variation across countries reported in the literature},
  keywords = {{FRANCE}},
  booktitle = {},
  journal = {{PL}o{S} {O}ne},
  volume = {15},
  numero = {12},
  pages = {e0243606 [18 ]},
  ISSN = {1932-6203},
  year = {2020},
  DOI = {10.1371/journal.pone.0243606},
  URL = {https://www.documentation.ird.fr/hor/fdi:010078816},
}