Table 2.

Factors associated with in-hospital COVID-19 mortality rate at the department level in metropolitan France

		Univariate analyses		Multivariate analysis
		SMR (95% CI)	p value	aSMR (95% CI)	p value
Number of in-hospital cases accumulated from March 18 to May 11, 2020		1·0002 (1·0001–1·0003)	<0·0001	1·0004 (1·0002–1·001)	<0·0001
Relative lag between first COVID-19-associated death and lockdown on March 17, 2020		1·03 (1·01–1·04)	0·0009	1·04 (1·02–1·06)	0·0001
Population age structure estimated in 2020 per department
	Class 1: high proportion aged 25–49 years	1 (ref)	..	1 (ref)	..
	Class 2: high proportion aged <25 years	0·85 (0·60–1·20)	0·36	1·30 (0·92–1·83)	0·14
	Class 3: high proportion aged 50–85 years	0·74 (0·51–1·06)	0·10	1·41 (0·89–2·22)	0·14
	Class 4: high proportion aged >85 years	0·96 (0·60–1·54)	0·87	2·17 (1·20–3·90)	0·010
Number of intensive care beds in 2018		1·002 (1·0004–1·003)	0·015	1·00 (0·99–1·003)	0·57
Number of new chloroquine and hydroxychloroquine dispensations in pharmacies from Jan 1 to April 19, 2020		1·001 (1·0002–1·001)	0·0054	1·00 (0·99–1·001)	0·28
Baseline population health and health-care services
	Class 1: high proportion of the population receiving home health assistance	1 (ref)	..	1 (ref)	..
	Class 2: high health professional density	1·19 (0·94–1·51)	0·15	0·94 (0·69–1·29)	0·70
	Class 3: high proportion of hospital stays	1·07 (0·82–1·38)	0·64	0·87 (0·61–1·23)	0·42

Analyses were made using generalised additive models with a negative binomial regression, a Gaussian kriging smoother based on geographical coordinates, and log(population) as an offset. The multivariate model included confounders according to the directed acyclic graph. aSMRs were adjusted on the different cofactors, spatial structure, and the interaction between COVID-19 cases and temporal progression of the epidemic wave (p=0·062). SMR=standardised mortality ratio. aSMR=adjusted standardised mortality ratio. Ref=reference.