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We read with interest the review by Dr Kohlmeier in which he reported a correlation between COVID-19 mortality among African-Americans across the USA and northern latitude.1 We previously reported a north–south gradient in global COVID-19 mortality but were conscious that lack of ultraviolet exposure and consequent vitamin D insufficiency was not the only possible explanation.2 We have now investigated the relationships between latitude, age of population, population density and pollution with COVID-19 mortality.
COVID-19 mortality per million by country was downloaded from https://www.worldometers.info/coronavirus/ on 18 May 2020.3 We included all 117 countries with population >1 million and ≥150 COVID-19 cases. Data by country for population %≥65 years, population density and air pollution (particles of matter <2.5 um diameter µg/m3) were obtained from public sources.4–6 Latitude was entered for each country’s capital city. The hypothesis was that there was no relationship between mortality and latitude below a threshold and that thereafter mortality increased with latitude. Mortality data were log transformed, and piecewise linear modelling was used to explore the relationship with latitude. This was adjusted for %≥65, and pollution and population …
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