Full Vaccination coverage, Smoking, Hypertension and COVID-19-associated Excess Mortality in Southeast Asia Region: GLMM analysis of Real-world Epidemiological Data

Abstract Background. From Wuhan (China) where its originated, COVID-19 has rapidly spread worldwide; mass vaccination and cardiometabolic disorders are reported to influence the disease prognosis and mortality burden. We applied a generalized linear mixed model (GLMM) to explore associations between COVID-19 mortality, full vaccination coverage and cardiometabolic health indicators in Southeast Asia region (SEAR).Methods. A region-wide ecological analysis of aggregate COVID-19 data of 10 SEAR countries (January 2020-December 2022) was performed. Databases used were from John Hopkins University Coronavirus Resource Center and WHO. Excess deaths associated with COVID-19/100,000 and case-fatality rate (CFR) were outcome variables. GLMM was performed to determine the predictors of COVID-19 mortality; adjustment was made for sociodemographics. Statistical significance level was set at p < 0.01 (double-sided).Results. Adjusted GLMM analysis showed that number of excess deaths due to COVID-19/100,000 was strongly and positively associated with age-standardized smoking (coeff.= 9.18 (SE: 2.15); p < 0.001) and hypertension prevalence (coeff.= 25.98 (SE: 9.15); p < 0.01), whereas it was strongly and negatively associated with full vaccination coverage rate (coeff.= -5.23 (SE: 1.54); p < 0.01) and log-transformed GDP per capita (coeff.= -102.01 (SE: 18.31); p < 0.001). COVID-19 CFR was positively associated with age-standardized hypertension prevalence (coeff.= 0.30 (SE: 0.16); p < 0.01), negatively with full vaccination coverage rate (coeff.= -0.05 (SE: 0.01); p < 0.01) and GDP per capita (coeff.= -1.09 (SE: 0.34); p < 0.01). The associations observed in the multivariate analysis remained true in the stratified analysis using quartiles.Conclusion. Study findings suggest that implementing effective public health interventions that increase vaccine uptake and improve cardiometabolic health would have reduced COVID-19 mortality in SEAR.