Primarily, 95% confidence intervals are direct extractions from your seroprevalence studies. for test performance. Sample size-weighted IFRs were estimated for countries with ETP-46321 multiple estimates. Thirteen seroprevalence surveys representing 11 high-income countries were included in the main analysis. Median IFR in community-dwelling elderly and elderly overall was 2.9% (range 1.8C9.7%) and 4.5% (range 2.5C16.7%) without accounting for seroreversion (2.2% and 4.0%, respectively, accounting for 5% monthly seroreversion). Multiple sensitivity analyses yielded comparable results. IFR was higher with larger proportions of people ?85?years. The IFR of COVID-19 in community-dwelling elderly is lower than previously reported. Supplementary Information The online version contains supplementary material available at 10.1007/s10654-022-00853-w. Not applicable (missing) *Seroprevalence corrected for test performance with the GladenCRogan formula since the initial source had not done so Mortality and populace statistics COVID-19 deaths and populace data among elderly at each ETP-46321 location are shown in Table ?Table11 (for sources, see Online Appendix Table 2). The proportion of a locations ETP-46321 total COVID-19 deaths that happened among elderly experienced a median of 86% (range 70C93%) in high-income countries. The proportion of a locations total COVID-19 deaths that occurred in long-term care residents experienced a median of 39% (range 20C67%) in in high-income countries with available data (for Qatar, the number was imputed). One study [55] included only COVID-19 deaths that occurred in nursing homes and was corrected to reflect also the deaths among residents occurring in hospitals. Among the population, the elderly group comprised a median of 14% (range 10C24%) in high-income countries. People residing in facilities were 4.8% (range 2.9C8.8%) in high-income countries. Additional data contributed Additional information was obtained from authors and companies on four studies for seroprevalence data [50, 56, 59, 60]; four studies for mortality data [49, 50, 34, 43]; two studies for populace data [49, 50]; and five excluded studies (clarifying non-eligibility). Calculated IFRs For countries with more than one IFR estimate available sample size-weighted average IFRs were calculated. In 11 high-income countries, IFRs in community-dwelling elderly (Fig.?1, Table ?Table1)1) experienced a CD9 median of 2.9% (range 1.8C9.7%). Physique?1 also shows 95% CIs for IFRs based on 95% CIs for seroprevalence estimates. For 5 studies, 95% CIs were direct extractions from your seroprevalence studies themselves, while complementary calculations were performed for the others as explained in Online Appendix Table 1. For 9 studies, seroprevalence estimates were corrected for test overall performance using the GladenCRogan formula (Online Appendix Table 4). Median IFR in all elderly for all those 11 high-income countries was 4.5% (range 2.5C16.7%). Of the 13 included estimates, the IFR in community-dwelling elderly was ?30% lower than the IFR among all elderly in 10/13 and ?50% lower in 1/13. Open in a separate windows Fig. 1 Contamination fatality rates (IFRs) in elderly, corrected for unmeasured antibody types. a Countries IFRs in community-dwelling elderly and elderly overall. b IFRs in community-dwelling elderly with 95% confidence intervals based on individual seroprevalence estimates and their uncertainty. If multiple seroprevalence studies were available for the same country, we calculated the sample size-weighted IFR. As per above, the 95% CIs do not take into account other sources of uncertainty than those adjusted by the seroprevalence study authors (except adding an adjustment for test overall performance as per the GladenCRogan formula for those that had not already adjusted for test overall performance), and should be interpreted as conservative. Primarily, 95% confidence intervals are direct extractions from your seroprevalence studies. For studies that did not report 95% confidence intervals, we complemented with a calculation using the number of sampled and seropositive elderly individuals. For those that provided adjusted estimates for age brackets (e.g., 70C79, 80C89, and 90+), we combined estimates for each study using a fixed effects inverse variance meta-analysis (of arcsine transformed proportions) to obtain 95% CIs. Asymmetry to point estimates may be observed for these cases, since point estimates were calculated by multiplying age bracket seroprevalence by the corresponding population count (which is preferable, since it takes into account populace distribution) With 5% relative monthly seroreversion, median IFR in community-dwelling elderly in 11 high-income countries was 2.2% (4.0% in all elderlysee details on seroreversion analyses in Online Appendix Table 5). Online Appendix Table 6 shows calculations with later cut-off for counting ETP-46321 deaths. The median IFR was 2.7% upon excluding 3 studies where the selected.