TY - JOUR T1 - Evaluation and Prediction of COVID-19 Case Fatality Rates from 156 countries JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2022.4631 VL - 60 IS - suppl 66 SP - 4631 AU - C Zhou AU - A Wheelock AU - C Zhang AU - Y Wang AU - W Liang AU - J Gao AU - L Xu Y1 - 2022/09/04 UR - http://erj.ersjournals.com/content/60/suppl_66/4631.abstract N2 - Background: Understanding the key factors affecting case fatality rates (CFRs) of COVID-19 is essential to guiding national response to pandemics. We aimed to investigate the country and period features of CFR in COVID-19 and predict the changes in CFR.Method: Cross-temporal and cross-country variations in CFR were identified by Extreme Gradient Boosting models using multiple features, and the effects of features were explained by applying SHapley Additive exPlanations.Results: The determinants of CFR changed during the COVID-19 pandemic from health conditions to a mixed effect dominated by vaccination rates (Fig 1). Overall, most countries have concurrent risk factors besides the main risk factors, and 156 countries were grouped into five clusters based on key CFR risk factors (Fig 1). A low vaccination rate drove cluster 1 was found primarily in sub-Saharan Africa and Latin America. Aging drove cluster 2, primarily distributed in the high-income European countries, and a high burden of disease characterises cluster 3 and low GDP related cluster 4 were scattered across continents. Furthermore, simulating a 5% increase in vaccination rates resulted in a 31.2% and 15.0% change in CFR for cluster 1 and cluster 3, respectively, but only 3.1% for cluster2. (Fig 1).Conclusion: The features affecting COVID-19 CFRs show diversity across countries, and declining CFRs require more than increasing vaccination coverage.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 4631.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -