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Taking account of heterogeneity in data completeness may thus help clarify analyses of the relationship between COVID-19 outcomes and standard preparedness measures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We examined country-level associations of pandemic preparedness capacities inventories, from the Global Health Security (GHS) Index and Joint External Evaluation (JEE), on SARS-CoV-2 infection and COVID-19 death data completion rates adjusted for income. Analyses were stratified by 100, 100\u2013300, 300\u2013500, and 500\u2013700\u00a0days after the first reported case in each country. We subsequently reevaluated the relationship of pandemic preparedness on SARS-CoV-2 infection and age-standardized COVID-19 death rates adjusted for cross-country differentials in data completeness during the pre-vaccine era.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Every 10% increase in the GHS Index was associated with a 14.9% (95% confidence interval 8.34\u201321.8%) increase in SARS-CoV-2 infection completion rate and a 10.6% (5.91\u201315.4%) increase in the death completion rate during the entire observation period. Disease prevention (infections: \u03b2\u2009=\u20091.08 [1.05\u20131.10], deaths: \u03b2\u2009=\u20091.05 [1.04\u20131.07]), detection (infections: \u03b2\u2009=\u20091.04 [1.01\u20131.06], deaths: \u03b2\u2009=\u20091.03 [1.01\u20131.05]), response (infections: \u03b2\u2009=\u20091.06 [1.00\u20131.13], deaths: \u03b2\u2009=\u20091.05 [1.00\u20131.10]), health system (infections: \u03b2\u2009=\u20091.06 [1.03\u20131.10], deaths: \u03b2\u2009=\u20091.05 [1.03\u20131.07]), and risk environment (infections: \u03b2\u2009=\u20091.27 [1.15\u20131.41], deaths: \u03b2\u2009=\u20091.15 [1.08\u20131.23]) were associated with both data completeness outcomes. Effect sizes of GHS Index on infection completion (Low income: \u03b2\u2009=\u20091.18 [1.04\u20131.34], Lower Middle income: \u03b2\u2009=\u20091.41 [1.16\u20131.71]) and death completion rates (Low income: \u03b2\u2009=\u20091.19 [1.09\u20131.31], Lower Middle income: \u03b2\u2009=\u20091.25 [1.10\u20131.43]) were largest in LMICs. After adjustment for cross-country differences in data completeness, each 10% increase in the GHS Index was associated with a 13.5% (4.80\u201321.4%) decrease in SARS-CoV-2 infection rate at 100\u00a0days and a 9.10 (1.07\u201316.5%) decrease at 300\u00a0days. For age-standardized COVID-19 death rates, each 10% increase in the GHS Index was with a 15.7% (5.19\u201325.0%) decrease at 100\u00a0days and a 10.3% (\u2212\u20090.00\u201319.5%) decrease at 300\u00a0days.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Results support the pre-pandemic hypothesis that countries with greater pandemic preparedness capacities have larger SARS-CoV-2 infection and mortality data completeness rates and lower COVID-19 disease burdens. More high-quality data of COVID-19 impact based on direct measurement are needed.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12963-024-00333-1","type":"journal-article","created":{"date-parts":[[2024,6,15]],"date-time":"2024-06-15T10:01:43Z","timestamp":1718445703000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Pandemic preparedness improves national-level SARS-CoV-2 infection and mortality data completeness: a cross-country ecologic analysis"],"prefix":"10.1186","volume":"22","author":[{"given":"Jorge R.","family":"Ledesma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Papanicolas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Stoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavroula A.","family":"Chrysanthopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Isaac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark N.","family":"Lurie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer B.","family":"Nuzzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,15]]},"reference":[{"issue":"10344","key":"333_CR1","doi-asserted-by":"publisher","first-page":"2351","DOI":"10.1016\/S0140-6736(22)00484-6","volume":"399","author":"RM Barber","year":"2022","unstructured":"Barber RM, Sorensen RJD, Pigott DM, Bisignano C, Carter A, Amlag JO, et al. 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