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Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing global health crisis, directly and indirectly impacting all spheres of human life Some pharmacological measures have been proposed to prevent COVID-19 or reduce its severity, such as vaccinations Previous reports indicate that influenza vaccination appears to be negatively correlated with COVID-19-associated mortality, perhaps as a result of heterologous immunity or changes in innate immunity The understanding of such trends in correlations could prevent deaths from COVID-19 in the future The aim of this study was therefore to analyze the association between COVID-19 related deaths and influenza vaccination rate (IVR) in elderly people worldwide Methods: To determine the association between COVID-19 deaths and influenza vaccination, available data sets from countries with more than 0 5 million inhabitants were analyzed (in total 39 countries) To accurately estimate the influence of IVR on COVID-19 deaths and mitigate effects of confounding variables, a sophisticated ranking of the importance of different variables was performed, including as predictor variables IVR and some potentially important geographical and socioeconomic variables as well as variables related to non-pharmaceutical intervention The associations were measured by non-parametric Spearman rank correlation coefficients and random forest functions Results: The results showed a positive association between COVID-19 deaths and IVR of people >= 65 years-old There is a significant increase in COVID-19 deaths from eastern to western regions in the world Further exploration is needed to explain these findings, and additional work on this line of research may lead to prevention of deaths associated with COVID-19

Positive association between COVID-19 deaths and influenza vaccination rates in elderly people worldwide