A cluster analysis of epidemiological and clinical factors associated with accumulation process of the burden of COVID-19 in European countries

Main Article Content

Sajad Shojaee
Pegah Eslami
Arash Dooghaie Moghadam
Mohamad Amin Pourhoseingholi
Sara Ashtari
Amir Vahedian-Azimi
Mohammad Reza Zali


European Countries, Clinical Factors, Epidemiological Factors, COVID-19, Cluster Analysis


Background and aim of the work

European COVID-19 statistics showed differentiation between mortality and new cases. Some studies suggested several factors including migration, cancer incidence, life expectancy and health system capacity maybe associated with differentiations. Up to now, impact of those factors in different European societies is not discussed and compared. Aim of the present study was to perform the cluster analysis in European countries in attention to clinical and epidemiological factors due to covid-19.


We collected some appropriate extreme data of COVID-19 to access the situations by ANOVA post-hoc test in 3 scenarios, as well as to estimate regression coefficients in simple linear regression, and a cluster analysis using average linkage. Covid-19 Statistics were considered in all analyses until April 24, 2020.


Among 39 European countries, several countries reported highest rate of confirmed cases included of Italy (current statues=2270.52) and Spain (current status=2616.24). The highest rate of mortality was seen in France (current status=242.16), Italy (current status=305.52). Life expectancy (female) (P=0.01, 95%Cl=1521.27,15264.58), migration (P<0.001, 95%Cl=41.42,96.72) had significant association with confirmed cases and death. Overall cancer death (P<0.001, 95%Cl=0.36,0.68; P<0.001, 95%Cl=0.01,0.07) and lung cancer death (P<0.001, 95%Cl=1.97,3.56; P<0.001, 95%Cl=0.09,0.37) associated with confirmed cases and mortality, too. We were also determined 5 clusters which more than 30 countries were categorized in the first cluster.


Demographic factors, including population, life expectancy and migration, underlying disorders, such as several types of cancers, especially lung cancers lead to various distribution of COVID-19 in terms of prevalence and mortality, across European counties.


Download data is not yet available.


Metrics Loading ...
Abstract 9 |


1. Lee A. Wuhan novel coronavirus (COVID-19): why global control is challenging? Public Health. 2020; 179:A1-A2. doi:10.1016/j.puhe.2020.02.001
2. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents. 2020:105955-. doi:10.1016/j.ijantimicag.2020.105955
3. Moazzami B, Razavi-Khorasani N, Dooghaie Moghadam A, Farokhi E, Rezaei N. COVID-19 and telemedicine: Immediate action required for maintaining healthcare providers well-being. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2020; 126:104345-. doi:10.1016/j.jcv.2020.104345
4. organisation Wwh. Coronavirus disease 2019 (COVID-19) Situation Report – 95. 2020,april,24. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200424-sitrep-95-covid-19.pdf?sfvrsn=e8065831_4.
5. Spiteri G, Fielding J, Diercke M, et al. First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020. Eurosurveillance. 2020; 25(9):2000178. doi:doi:https://doi.org/10.2807/1560-7917.ES.2020.25.9.2000178
6. organisation wwh. Coronavirus disease 2019 (COVID-19) Situation Report – 85. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4. Accessed april 14 2020.
7. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. The Lancet. Infectious diseases. 2020. doi:10.1016/s1473-3099(20)30243-7
8. Mahase E. Covid-19: death rate is 0.66% and increases with age, study estimates. BMJ (Clinical research ed.). 2020; 369:m1327. doi:10.1136/bmj.m1327
9. Ling L, Joynt GM, Lipman J, Constantin JM, Joannes-Boyau O. COVID-19: A critical care perspective informed by lessons learnt from other viral epidemics. Anaesthesia, critical care & pain medicine. 2020; 39(2):163-6. doi:10.1016/j.accpm.2020.02.002
10. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. The European respiratory journal. 2020. doi:10.1183/13993003.00547-2020
11. Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol. 2020; 150:102972-. doi:10.1016/j.critrevonc.2020.102972
12. Calabrò L, Peters S, Soria J-C, et al. Challenges in lung cancer therapy during the COVID-19 pandemic. Lancet Respir Med. 2020:S2213-600(20)30170-3. doi:10.1016/S2213-2600(20)30170-3
13. RamiKrispin/coronavirus. The coronavirus dataset. 2020,april,24. https://github.com/RamiKrispin/coronavirus.
14. Sevcikova H. Explorer of World Population Prospects. 2020,april,9
15. Cancer IAfRo. Estimated number of new cases in 2018, worldwide, both sexes, all ages. 2020,april,24. https://gco.iarc.fr/today/online-analysis-table?v=2018&mode=cancer&mode_population=continents&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=1&include_nmsc_other=1.
16. ECONOMICS T. TRADING ECONOMICS. 2020,april,24. https://tradingeconomics.com/indicators.
17. NUMBEO. Quality of Life Index by Country 2020. 2020,april,24. https://www.numbeo.com/quality-of-life/rankings_by_country.jsp.
18. Spiteri G, Fielding J, Diercke M, et al. First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020. Euro Surveill. 2020; 25(9):2000178. doi:10.2807/1560-7917.ES.2020.25.9.2000178
19. Fan C, Liu L, Guo W, et al. Prediction of Epidemic Spread of the 2019 Novel Coronavirus Driven by Spring Festival Transportation in China: A Population-Based Study. International journal of environmental research and public health. 2020; 17(5). doi:10.3390/ijerph17051679
20. Hargreaves S, Kumar BN, McKee M, Jones L, Veizis A. Europe’s migrant containment policies threaten the response to covid-19. BMJ (Clinical research ed.). 2020; 368:m1213. doi:10.1136/bmj.m1213
21. Carta MG, Orrù G, Scano A, et al. In the face of the SARS-CoV-2 outbreak, do people suffering from oncological disease need specific attention? European review for medical and pharmacological sciences. 2020; 24(7):3434-6. doi:10.26355/eurrev_202004_20794
22. Zhao Z, Bai H, Duan J, Wang J. Recommendations of individualized medical treatment and common adverse events management for lung cancer patients during the outbreak of COVID-19 epidemic. Thoracic cancer. 2020. doi:10.1111/1759-7714.13424
23. Banna G, Curioni-Fontecedro A, Friedlaender A, Addeo A. How we treat patients with lung cancer during the SARS-CoV-2 pandemic: primum non nocere. ESMO open. 2020; 5(2). doi:10.1136/esmoopen-2020-000765
24. Hanna TP, Evans GA, Booth CM. Cancer, COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. Nature reviews. Clinical oncology. 2020; 17(5):268-70. doi:10.1038/s41571-020-0362-6