RT Journal Article SR Electronic T1 Inverse correlates of COVID-19 mortality across European countries during the first versus subsequent waves JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e006422 DO 10.1136/bmjgh-2021-006422 VO 6 IS 8 A1 Leonardo Villani A1 Roberta Pastorino A1 Walter Ricciardi A1 John Ioannidis A1 Stefania Boccia YR 2021 UL http://gh.bmj.com/content/6/8/e006422.abstract AB The objectives of the study were to calculate the standardised mortality rates (SMRs) for COVID-19 in European Union/European Economic Area countries plus the UK and Switzerland and to evaluate the correlation between SMRs and selected indicators in the first versus the subsequent waves until 23 June 2021. We used indirect standardisation (using Italy as the reference) to compute SMRs and considered 16 indicators of health and social well-being, health system capacity and COVID-19 response. The highest SMRs were in Belgium, the UK and Spain in the first wave (1.20–1.84) and in Hungary, Czechia and Slovakia in the subsequent waves (2.50–2.69). Human Development Index (HDI), life expectancy, urbanisation and healthcare expenditure had positive correlations with SMR in the first wave (rho=0.30–0.46), but negative correlations (rho=−0.67 to −0.47) in the subsequent waves. Retail/recreation mobility and transit mobility were negatively correlated with SMR in the first wave, while transit mobility was inversely correlated with SMR in the subsequent waves. The first wave hit most hard countries with high HDI, high life expectancy, high urbanisation, high health expenditures and high tourism. This pattern may reflect higher early community seeding and circulation of the virus. Conversely, in the subsequent waves, this pattern was completely inversed: countries with more resources and better health status did better than eastern European countries. While major SMR differences existed across countries in the first wave, these differences largely dissipated by 23 June 2021, with few exceptions.All data relevant to the study are included in the article or uploaded as supplementary information. All data were collected from International Data Base. We obtained data from the Eurostat Database, the United Nations Database, the World Bank, the European Observatory on Health Systems and Polices, the Organisation for Economic Co-operation and Development, the Our World in Data database and the scientific literature.