ABSTRACT
Objective: To analyze sociodemographic factors' influence on COVID-19 case fatality rate (CFR) in Ecuador on a subnational level. Methods: Publicly available register-based observational study. A retrospective cohort of COVID-19 infections between epidemiological weeks 8-53 in the Ecuadorian public healthcare system was determined from available records. Statistical analyses were conducted to evaluate CFR trends according to factors such as sex, age, location, and healthcare provider. Results: Overall CFR was 9.4%; by canton, median CFR was 5.2%, with some cantons with much higher rates, like Santa Elena (39.1%). Overall CFR decreased during the period, from 16.6% (week 8) to 2.63% (week 53). Being in a rural area was an independent protective factor. Patients over 65 had a hazard ratio of 11.38 (95% CI [11.05, 11.72]). Sex, ethnicity, and treatment from public facilities were also associated with death risk. Conclusion: CFR is a proxy indicator of COVID-19 impact in Ecuador, and this location-based analysis provides new information on the disease's specific impact subnationally. Overall COVID-19 CFR during the entire period was high, suggesting the need to improve COVID-19 care in Ecuador.