{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T07:21:11Z","timestamp":1792653671468,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Health risk perception and factors associated with the severity or death from COVID-19 were key elements that influenced individuals' protective behaviors during the pandemic. Understanding these perceptions is crucial for public health guidelines that encourage preventive measures and improve an outbreak response strategy. Thus, this systematic review aimed to identify factors associated with the perception of risk of severity or death from COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted with an article search performed in March 2024 across five databases, utilizing both controlled and free vocabulary. Studies published from 2020 onward were included. Two reviewers independently selected articles, with disagreements resolved by a third reviewer. The data were extracted using a structured form, and the findings were synthesized narratively. The studies included in the review underwent a methodological quality assessment using tools proposed by the Joanna Briggs Institute.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nineteen articles were included in the review. Among the factors most frequently associated with the perception of severe illness or death from COVID-19 were advanced age, female gender, personal experience or witnessing of adverse COVID-19 outcomes, the presence of chronic non-communicable diseases, and lower educational attainment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study highlights that the perception of risk for COVID-19 severity or death varied according to age, gender, and prior experiences with the disease. Such findings can guide healthcare practices and contribute to the formulation of public policies, strengthening responses to future public health crises.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p>identifier CRD42024444734, <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024444734<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1543629","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T05:16:25Z","timestamp":1748236585000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Risk perception of severity or death from COVID-19: a systematic review of the factors associated"],"prefix":"10.3389","volume":"13","author":[{"given":"Rander Junior","family":"Rosa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubia Laine de Paula","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia","family":"Perticarrara Ferezin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f4nica Chiodi Toscano","family":"de Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heriederson S\u00e1vio Dias","family":"Moura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thais Zamboni","family":"Berra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natacha Martins","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titilade Kehinde Ayandeyi","family":"Teibo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Luiz Teixeira","family":"Vinci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Mendes Delpino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel \u00c1ngel Fuentealba","family":"Torres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Alexandre","family":"Arc\u00eancio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s11033-022-07907-y","article-title":"Association of the matrix metalloproteinases (MMPs) family gene polymorphisms and the risk of coronavirus disease 2019 (COVID-19); implications of contribution for development of neurological symptoms in the COVID-19 patients","volume":"50","author":"Ramezani","year":"2023","journal-title":"Mol Biol Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/j.1539-6924.1995.tb00308.x","article-title":"Risk perception and communication unplugged: twenty years of process 1","volume":"15","author":"Fischhoff","year":"1995","journal-title":"Risk analysis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1080\/13669877.2020.1758193","article-title":"Risk perceptions of COVID-19 around the world","volume":"23","author":"Dryhurst","year":"2020","journal-title":"J Risk Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.3390\/jcm9061802","article-title":"The enemy which sealed the world: effects of COVID-19 diffusion on the psychological state of the Italian population","volume":"9","author":"Forte","year":"2020","journal-title":"J Clin Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID-19-related death using OpenSAFELY","volume":"584","author":"Williamson","year":"2020","journal-title":"Nature"},{"key":"B6","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1159\/000294151","article-title":"Risk perceptions and family history of lung cancer: differences by smoking status","volume":"14","author":"Chen","year":"2010","journal-title":"Public Health Genomics."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e2100411118","DOI":"10.1073\/pnas.2100411118","article-title":"Worldviews, trust, and risk perceptions shape public acceptance of COVID-19 public health measures","volume":"118","author":"Siegrist","year":"2021","journal-title":"Proc Nat Acad Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1080\/13669877.2022.2142951","article-title":"Individual characteristics or cultures? 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