General and COVID-19-Related Mortality by Pre-Existing Chronic Conditions and Care Setting during 2020 in Emilia-Romagna Region, Italy

Abstract

In 2020, the number of deaths increased in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims to describe trends in mortality and to quantify excess mortality variability over time and in relation to demographics, pre-existent chronic conditions and care setting of the Emilia-Romagna region (Northern Italy). This is a registry-based cross-sectional study comparing the 2020 observed mortality with figures of the previous five years by age, sex, month, place of death, and chronicity. It includes 300,094 deaths in those 18 years of age and above resident in the Emilia-Romagna region. Excess deaths were higher during the first pandemic wave, particularly among men and in March. Age-adjusted risk was similar among both men and women (Mortality Rate Ratio 1.15; IC95% 1.14–1.16). It was higher among females aged 75+ years and varied between sub-periods. Excluding COVID-19 related deaths, differences in the risk of dying estimates tended to disappear. Metabolic and neuropsychiatric diseases were more prevalent among those that deceased in 2020 compared to the deaths that occurred in 2015–2019 and therefore can be confirmed as elements of increased frailty, such as being in long-term care facilities or private homes as the place of death. Understanding the impact of the pandemic on mortality considering frailties is relevant in a changing scenario.

The effect of diabetes on COVID-19 incidence and mortality: Differences between highly-developed-country and high-migratory-pressure-country populations

“…It is worth noting that our results did not confirm the excess of SARS-CoV-2 infections and COVID-19 mortality reported by studies conducted in the UK and the USA for populations of Asian and African origin. Our results are consistent with other Italian studies ( 46 , 47 ), which also reported a lower incidence of COVID-19 among immigrants ( 11 ), while COVID-19 mortality depended on the period considered, alternating phases of slightly lower mortality among immigrants and vice versa ( 12 , 28 ). This occurred despite the fact that vaccine coverage was lower in the HMPC population than in the HDC population.…”

“…We focused on mortality and not on fatality rates to measure the impact of diabetes on COVID-19 severity because, based on the assumption of more limited testing in immigrants and consequent undiagnosed disease, the incidence of infection in immigrants may be underestimated, thus overestimating fatality. Actually, in Emilia-Romagna Region, a reduced probability of testing has been demonstrated, especially for women ( 9 ) from HMPC populations ( 27 ), and increased screening activity related to international traveling has also been observed in people from HPMCs ( 28 ).…”

Invasive Meningococcal Disease and Meningococcal Serogroup B Vaccination in Adults and Their Offspring: Knowledge, Attitudes, and Practices in Italy (2019)

“…In this regard, the very same timeframe of our inquiry may represent both a substantial limit and also a potential strength of the present study, as the provinces of Parma and Reggio Emilia were extensively affected by the SARS-CoV-2 pandemic [ 99 , 100 , 101 ], particularly between March and May 2020; as a consequence, our study could share a “historical” picture of KAP on vaccination policies on MenB shortly before an event that has reasonably affected the overall acceptance of vaccines, potentially contributing to future studies as a reference [ 31 , 38 , 39 , 83 , 85 ].…”

Infodemiology of RSV in Italy (2017–2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age?

“…Fifth, it should be stressed that the early stages of the SARS-CoV-2 pandemic mostly occurred unnoticed to the Italian general population: as recently pointed out by some studies [ 97 , 98 , 99 , 100 ], well before the official diagnosis of first cases of COVID-19 (i.e., 21 February 2020), Italy reasonably experienced a certain circulation of this pathogen. The clinical characteristics of milder cases may have therefore led to a transient surge in both searches for topics correlated with respiratory disorders and to ILI notification rates, that then were conversely affected by the implementation of lockdown measures [ 99 , 101 , 102 , 103 ]. Nevertheless, despite intensive retrospective research, particularly on a series of viral Pneumonia cases that occurred in the second half of 2019, the actual circulation of SARS-CoV-2 before February 2020 remains unclear [ 104 , 105 , 106 , 107 ].…”