Representative Estimates of COVID-19 Infection Fatality Rates from Three Locations in India

There are very few estimates of the age-specific infection fatality rate (IFR) of SARS-CoV-2 in low- and middle-income countries. India reports the second highest number of SARS-CoV-2 infections in the world. We estimate age-specific IFR using data from seroprevalence surveys in Mumbai (population 12 million) and Karnataka (population 61 million), and a random sample of economically distressed migrants in Bihar with mortality followup. Among men aged 50-89, IFR is 0.12% in Karnataka (95% C.I. 0.09%-0.15%), 0.53% in Mumbai (0.52%-0.54%), and 5.64% among migrants in Bihar (0-11.16%). IFR in India is approximately twice as high for men as for women, is heterogeneous across contexts, and rises much less at older ages than in comparable studies from high income countries.