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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial Variation in Excess Mortality Across Europe: A Cross-Sectional Study of 561 Regions in 21 Countries. J Epidemiol Glob Health 2024; 14:470-479. [PMID: 38376764 PMCID: PMC11176282 DOI: 10.1007/s44197-024-00200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. METHODS Statistical and demographic analyses of regional all-cause mortality data provided by the vital statistics systems of 21 European countries for 561 regions in Central and Western Europe. Life expectancy losses at ages 0 and 60 for males and females were estimated. RESULTS We found evidence of a loss in life expectancy in 391 regions, whilst only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years and three regions showed losses greater than 3 years. We highlight geographical clusters of high mortality in Northern Italy, Spain and Poland, whilst clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden. CONCLUSIONS Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France.
| | - Pavel Grigoriev
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | | | - Carlo-Giovanni Camarda
- French Institute for Demographic Studies (INED), 9 cours des Humanités, 93300, Aubervilliers, France
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Bonnet F, Grigoriev P, Sauerberg M, Alliger I, Mühlichen M, Camarda CG. Spatial disparities in the mortality burden of the covid-19 pandemic across 569 European regions (2020-2021). Nat Commun 2024; 15:4246. [PMID: 38762653 PMCID: PMC11102496 DOI: 10.1038/s41467-024-48689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
Since its emergence in December 2019, the COVID-19 pandemic has resulted in a significant increase in deaths worldwide. This article presents a detailed analysis of the mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce age and sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a forecasting approach based on CP-splines that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). We also estimate that eight regions suffered losses exceeding 20 years of life per 1000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic's impact.
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Affiliation(s)
- Florian Bonnet
- French Institute for Demographic Studies (INED), Aubervilliers, France.
| | - Pavel Grigoriev
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Markus Sauerberg
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
| | - Ina Alliger
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
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Bonnet F, Camarda CG. Estimating subnational excess mortality in times of pandemic. An application to French départements in 2020. PLoS One 2024; 19:e0293752. [PMID: 38241216 PMCID: PMC10798530 DOI: 10.1371/journal.pone.0293752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/18/2023] [Indexed: 01/21/2024] Open
Abstract
The COVID-19 pandemic's uneven impact on subnational regions highlights the importance of understanding its local-level mortality impact. Vital statistics are available for an increasing number of countries for 2020, 2021, and 2022, facilitating the computation of subnational excess mortality and a more comprehensive assessment of its burden. However, this calculation faces two important methodological challenges: it requires appropriate mortality projection models; and small populations imply considerable, though commonly neglected, uncertainty in the estimates. We address both issues using a method to forecast mortality at the subnational level, which incorporates uncertainty in the computation of mortality measures. We illustrate our approach by examining French départements (NUTS 3 regions, or 95 geographical units), and produce sex-specific estimates for 2020. This approach is highly flexible, allowing one to estimate excess mortality during COVID-19 in most demographic scenarios and for past pandemics.
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Affiliation(s)
- Florian Bonnet
- Institut national d’études démographiques (INED), Aubervilliers, France
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Golinelli D, Guarducci G, Sanna A, Lenzi J, Sanmarchi F, Fantini MP, Montomoli E, Nante N. Regional and sex inequalities of avoidable mortality in Italy: A time trend analysis. PUBLIC HEALTH IN PRACTICE 2023; 6:100449. [PMID: 38028252 PMCID: PMC10643453 DOI: 10.1016/j.puhip.2023.100449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study provides a comprehensive analysis of avoidable mortality (AM), treatable mortality (TM), and preventable mortality (PM) across Italy, focusing on region- and gender-specific inequalities over a 14-year period. Study design Time-trend analysis (2006-2019). Methods The study was conducted using mortality data from the Italian Institute of Statistics to evaluate the extent and patterns of AM, TM, and PM in Italy. Biennial age-standardized mortality rates were calculated by gender and region using the joint OECD/Eurostat list. Results The overall AM rates showed a large reduction from 2006/7 (221.0 per 100,000) to 2018/9 (166.4 per 100,000). Notably, females consistently displayed lower AM rates than males. Furthermore, both gender differences and the North-South gap of AM decreased during the period studied. The regions with the highest AM rates fluctuated throughout the study period. The highest percentage decrease in AM from 2006/7 to 2018/9, for both males (-41.3 %) and females (-34.2 %), was registered in the autonomous province of Trento, while the lowest reduction was observed in Molise for males (-17.4 %) and in Marche for females (-10.0 %). Conclusions Remarkable gender and regional differences in AM between 2006 and 2019 have been recorded in Italy, although they have decreased over years. Continuous monitoring of AM and the implementation of region- and gender-specific interventions is essential to provide valuable insights for both policy and public health practice. This study contributes to the efforts to improve health equity between Italian regions.
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Affiliation(s)
- Davide Golinelli
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
| | | | - Andrea Sanna
- Post Graduate School of Public Health, University of Siena, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Italy
- VisMederi S.r.l., Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, Italy
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5
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Levitt M, Zonta F, Ioannidis JPA. Excess death estimates from multiverse analysis in 2009-2021. Eur J Epidemiol 2023; 38:1129-1139. [PMID: 37043153 PMCID: PMC10090741 DOI: 10.1007/s10654-023-00998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Abstract
Excess death estimates have great value in public health, but they can be sensitive to analytical choices. Here we propose a multiverse analysis approach that considers all possible different time periods for defining the reference baseline and a range of 1 to 4 years for the projected time period for which excess deaths are calculated. We used data from the Human Mortality Database on 33 countries with detailed age-stratified death information on an annual basis during the period 2009-2021. The use of different time periods for reference baseline led to large variability in the absolute magnitude of the exact excess death estimates. However, the relative ranking of different countries compared to others for specific years remained largely unaltered. The relative ranking of different years for the specific country was also largely independent of baseline. Averaging across all possible analyses, distinct time patterns were discerned across different countries. Countries had declines between 2009 and 2019, but the steepness of the decline varied markedly. There were also large differences across countries on whether the COVID-19 pandemic years 2020-2021 resulted in an increase of excess deaths and by how much. Consideration of longer projected time windows resulted in substantial shrinking of the excess deaths in many, but not all countries. Multiverse analysis of excess deaths over long periods of interest can offer an approach that better accounts for the uncertainty in estimating expected mortality patterns, comparative mortality trends across different countries, and the nature of observed mortality peaks.
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Affiliation(s)
- Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA, 94305, USA
| | - Francesco Zonta
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, 201210, China
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, 94305, USA.
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Steul K, Heudorf U, Uphoff H, Kowall B. Excess mortality during the SARS-CoV-2 pandemic in the City of Frankfurt/Main, Germany, in 2020 and 2021, adjusted for age trends and pandemic phases. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc08. [PMID: 37261058 PMCID: PMC10227495 DOI: 10.3205/dgkh000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Excess mortality during the SARS-CoV-2 pandemic has been studied in many countries. Accounting for population aging has important implications for excess mortality estimates. We show the importance of adjustment for age trends in a small-scale mortality analysis as well as the importance of analysing different pandemic phases for mortality in an urban population. Methods Population data for Frankfurt/Main for 2016-2021 were obtained from the Municipal Office of Statistics, City of Frankfurt/Main. Mortality data from 2016 to 2021 were provided by the Hessian State Authority. For standardized mortality ratios (SMR=observed number of deaths divided by the expected number of deaths), the expected number of deaths was calculated in two ways: For SMRcrude, the mean mortality rate from the years 2016-2019 was multiplied by the total number of residents in 2020 and 2021 separately. For SMRadjusted, this procedure was performed separately for five age groups, and the numbers of expected deaths per age group were added. Results SMRcrude was 1.006 (95% CI: 0.980-1.031) in 2020, and 1.047 (95% CI: 1.021-1.073) in 2021. SMRadjusted was 0.976 (95% CI: 0.951-1.001) in 2020 and 0.998 (95% CI: 0.973-1.023) in 2021. Excess mortality was observed during pandemic wave 2, but not during pandemic waves 1 and 3. Conclusion Taking the aging of the population into account, no excess mortality was observed in Frankfurt/Main in 2020 and 2021. Without adjusting for population aging trends in Frankfurt /Main, mortality would have been greatly overestimated.
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Affiliation(s)
- Katrin Steul
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ursel Heudorf
- Institute of Hygiene and Environmental Medicine, Justus Liebig University, Giessen, Germany
| | - Helmut Uphoff
- Department of Infectious Disease Epidemiology, Hessian State Examination and Investigation Office in Health Care (HLPUG), Dillenburg, Germany
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany
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Levitt M, Zonta F, Ioannidis J. Excess death estimates from multiverse analysis in 2009-2021. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2022.09.21.22280219. [PMID: 36172123 PMCID: PMC9516863 DOI: 10.1101/2022.09.21.22280219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Excess death estimates have great value in public health, but they can be sensitive to analytical choices. Here we propose a multiverse analysis approach that considers all possible different time periods for defining the reference baseline and a range of 1 to 4 years for the projected time period for which excess deaths are calculated. We used data from the Human Mortality Database on 33 countries with detailed age-stratified death information on an annual basis during the period 2009-2021. The use of different time periods for reference baseline led to large variability in the absolute magnitude of the exact excess death estimates. However, the relative ranking of different countries compared to others for specific years remained largely unaltered. The relative ranking of different years for the specific country was also largely independent of baseline. Averaging across all possible analyses, distinct time patterns were discerned across different countries. Countries had declines between 2009 and 2019, but the steepness of the decline varied markedly. There were also large differences across countries on whether the COVID-19 pandemic years 2020-2021 resulted in an increase of excess deaths and by how much. Consideration of longer projected time windows resulted in substantial shrinking of the excess deaths in many, but not all countries. Multiverse analysis of excess deaths over long periods of interest can offer a more unbiased approach to understand comparative mortality trends across different countries, the range of uncertainty around estimates, and the nature of observed mortality peaks.
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Ceccarelli E, Minelli G, Egidi V, Jona Lasinio G. Assessment of Excess Mortality in Italy in 2020-2021 as a Function of Selected Macro-Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2812. [PMID: 36833508 PMCID: PMC9956038 DOI: 10.3390/ijerph20042812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Excess mortality (EM) can reliably capture the impact of a pandemic, this study aims at assessing the numerous factors associated with EM during the COVID-19 pandemic in Italy. METHODS Mortality records (ISTAT 2015-2021) aggregated in the 610 Italian Labour Market Areas (LMAs) were used to obtain the EM P-scores to associate EM with socioeconomic variables. A two-step analysis was implemented: (1) Functional representation of EM and clustering. (2) Distinct functional regression by cluster. RESULTS The LMAs are divided into four clusters: 1 low EM; 2 moderate EM; 3 high EM; and 4 high EM-first wave. Low-Income showed a negative association with EM clusters 1 and 4. Population density and percentage of over 70 did not seem to affect EM significantly. Bed availability positively associates with EM during the first wave. The employment rate positively associates with EM during the first two waves, becoming negatively associated when the vaccination campaign began. CONCLUSIONS The clustering shows diverse behaviours by geography and time, the impact of socioeconomic characteristics, and local governments and health services' responses. The LMAs allow to draw a clear picture of local characteristics associated with the spread of the virus. The employment rate trend confirmed that essential workers were at risk, especially during the first wave.
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Affiliation(s)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Viviana Egidi
- Department of Statistical Sciences, La Sapienza University, 00185 Rome, Italy
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Ceccarelli E, Dorrucci M, Minelli G, Jona Lasinio G, Prati S, Battaglini M, Corsetti G, Bella A, Boros S, Petrone D, Riccardo F, Maruotti A, Pezzotti P. Assessing COVID-19-Related Excess Mortality Using Multiple Approaches-Italy, 2020-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416998. [PMID: 36554878 PMCID: PMC9779266 DOI: 10.3390/ijerph192416998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Excess mortality (EM) is a valid indicator of COVID-19's impact on public health. Several studies regarding the estimation of EM have been conducted in Italy, and some of them have shown conflicting values. We focused on three estimation models and compared their results with respect to the same target population, which allowed us to highlight their strengths and limitations. METHODS We selected three estimation models: model 1 (Maruotti et al.) is a Negative-Binomial GLMM with seasonal patterns; model 2 (Dorrucci et al.) is a Negative Binomial GLM epidemiological approach; and model 3 (Scortichini et al.) is a quasi-Poisson GLM time-series approach with temperature distributions. We extended the time windows of the original models until December 2021, computing various EM estimates to allow for comparisons. RESULTS We compared the results with our benchmark, the ISS-ISTAT official estimates. Model 1 was the most consistent, model 2 was almost identical, and model 3 differed from the two. Model 1 was the most stable towards changes in the baseline years, while model 2 had a lower cross-validation RMSE. DISCUSSION Presently, an unambiguous explanation of EM in Italy is not possible. We provide a range that we consider sound, given the high variability associated with the use of different models. However, all three models accurately represented the spatiotemporal trends of the pandemic waves in Italy.
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Affiliation(s)
- Emiliano Ceccarelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence:
| | - Maria Dorrucci
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy
| | | | - Sabrina Prati
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, 00184 Rome, Italy
| | - Marco Battaglini
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, 00184 Rome, Italy
| | - Gianni Corsetti
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, 00184 Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Stefano Boros
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Antonello Maruotti
- Dipartimento GEPLI, Libera Università Maria Ss Assunta, 00193 Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
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Global Excess Mortality during COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10101702. [PMID: 36298567 PMCID: PMC9607451 DOI: 10.3390/vaccines10101702] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Currently, reported COVID-19 deaths are inadequate to assess the impact of the pandemic on global excess mortality. All-cause excess mortality is a WHO-recommended index for assessing the death burden of COVID-19. However, the global excess mortality assessed by this index remains unclear. We aimed to assess the global excess mortality during the COVID-19 pandemic. Methods: We searched PubMed, EMBASE, and Web of Science for studies published in English between 1 January 2020, and 21 May 2022. Cross-sectional and cohort studies that reported data about excess mortality during the pandemic were included. Two researchers independently searched the published studies, extracted data, and assessed quality. The Mantel–Haenszel random-effects method was adopted to estimate pooled risk difference (RD) and their 95% confidence intervals (CIs). Results: A total of 79 countries from twenty studies were included. During the COVID-19 pandemic, of 2,228,109,318 individuals, 17,974,051 all-cause deaths were reported, and 15,498,145 deaths were expected. The pooled global excess mortality was 104.84 (95% CI 85.56–124.13) per 100,000. South America had the highest pooled excess mortality [134.02 (95% CI: 68.24–199.80) per 100,000], while Oceania had the lowest [−32.15 (95% CI: −60.53–−3.77) per 100,000]. Developing countries had higher excess mortality [135.80 (95% CI: 107.83–163.76) per 100,000] than developed countries [68.08 (95% CI: 42.61–93.55) per 100,000]. Lower middle-income countries [133.45 (95% CI: 75.10–191.81) per 100,000] and upper-middle-income countries [149.88 (110.35–189.38) per 100,000] had higher excess mortality than high-income countries [75.54 (95% CI: 53.44–97.64) per 100,000]. Males had higher excess mortality [130.10 (95% CI: 94.15–166.05) per 100,000] than females [102.16 (95% CI: 85.76–118.56) per 100,000]. The population aged ≥ 60 years had the highest excess mortality [781.74 (95% CI: 626.24–937.24) per 100,000]. Conclusions: The pooled global excess mortality was 104.84 deaths per 100,000, and the number of reported all-cause deaths was higher than expected deaths during the global COVID-19 pandemic. In South America, developing and middle-income countries, male populations, and individuals aged ≥ 60 years had a heavier excess mortality burden.
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Levitt M, Zonta F, Ioannidis JPA. Comparison of pandemic excess mortality in 2020-2021 across different empirical calculations. ENVIRONMENTAL RESEARCH 2022; 213:113754. [PMID: 35753371 PMCID: PMC9225924 DOI: 10.1016/j.envres.2022.113754] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 05/02/2023]
Abstract
Different modeling approaches can be used to calculate excess deaths for the COVID-19 pandemic period. We compared 6 calculations of excess deaths (4 previously published [3 without age-adjustment] and two new ones that we performed with and without age-adjustment) for 2020-2021. With each approach, we calculated excess deaths metrics and the ratio R of excess deaths over recorded COVID-19 deaths. The main analysis focused on 33 high-income countries with weekly deaths in the Human Mortality Database (HMD at mortality.org) and reliable death registration. Secondary analyses compared calculations for other countries, whenever available. Across the 33 high-income countries, excess deaths were 2.0-2.8 million without age-adjustment, and 1.6-2.1 million with age-adjustment with large differences across countries. In our analyses after age-adjustment, 8 of 33 countries had no overall excess deaths; there was a death deficit in children; and 0.478 million (29.7%) of the excess deaths were in people <65 years old. In countries like France, Germany, Italy, and Spain excess death estimates differed 2 to 4-fold between highest and lowest figures. The R values' range exceeded 0.3 in all 33 countries. In 16 of 33 countries, the range of R exceeded 1. In 25 of 33 countries some calculations suggest R > 1 (excess deaths exceeding COVID-19 deaths) while others suggest R < 1 (excess deaths smaller than COVID-19 deaths). Inferred data from 4 evaluations for 42 countries and from 3 evaluations for another 98 countries are very tenuous. Estimates of excess deaths are analysis-dependent and age-adjustment is important to consider. Excess deaths may be lower than previously calculated.
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Affiliation(s)
- Michael Levitt
- Department of Structural Biology, Stanford University, Stanford, CA 94305, USA
| | - Francesco Zonta
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, Shanghai, 201210, China
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA 94305, USA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA 94305, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA; Department of Statistics, Stanford University, Stanford, CA 94305, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA 94305, USA.
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12
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Rizzi S, Strozza C, Zarulli V. Sex-differences in excess death risk during the COVID-19 pandemic: an analysis of the first wave across Italian regions. What have we learned? GENUS 2022; 78:24. [PMID: 35966179 PMCID: PMC9362380 DOI: 10.1186/s41118-022-00172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
In this commentary, we bring together knowledge on sex-differences in excess death during the first wave of the COVID-19 pandemic in Italy, one of the most hit European countries. We zoom into Italian regions to account for the spatial gradient of the spread of the virus. Analyses of excess death by sex during the COVID-19 pandemic have been possible thanks to weekly mortality data released by national statistical offices, mainly in developed countries. The general finding is that males up to 75 years old have been suffering more excess death compared to females. However, the picture is less clear-cut at older ages. During previous epidemics, such as SARS, Swine Flu, and MERS, studies are limited and produce scattered, non-conclusive evidence. Knowledge of the sex-pattern of susceptibility to mortality from virulent respiratory diseases and its interplay with age could improve crisis management during future epidemics and pandemics. National statistical offices should provide weekly mortality data with spatial granularity, disaggregated by sex and age groups, to allow for such analyses.
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Wang SY, Seghieri C, Vainieri M, Groene O. Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations During COVID-19 Pandemic in Tuscany-An Interrupted Time Series Study. Int J Public Health 2022; 67:1604319. [PMID: 35755955 PMCID: PMC9216172 DOI: 10.3389/ijph.2022.1604319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: We evaluate the impact of the COVID-19 pandemic on unplanned hospitalization rates for patients without COVID-19, including their length of stay, and in-hospital mortality, overall, and for acute myocardial infarction (AMI), stroke, and heart failure in the Tuscany region of Italy. Methods: We carried out a population-based controlled interrupted time series study using segmented linear regression with an autoregressive error term based on admissions data from all public hospitals in Tuscany. The primary outcome measure was weekly hospitalization rates; secondary outcomes included length of stay, and in-hospital mortality. Results: The implementation of the pandemic-related mitigation measures and fear of infection was associated with large decreases in inpatient hospitalization rates overall (-182 [-234, -130]), unplanned hospitalization (-39 [-51, -26]), and for AMI (-1.32 [-1.98, -0.66]), stroke (-1.51 [-2.56, -0.44]), and heart failure (-8.7 [-11.1, -6.3]). Average length of stay and percent in-hospital mortality for select acute medical conditions did not change significantly. Conclusion: In Tuscany, Italy, the COVID-19 pandemic was associated with large reductions in hospitalization rates overall, as well as for heart failure, and the time sensitive conditions of AMI and stroke during the months January to July 2020.
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Affiliation(s)
- Sophie Y Wang
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.,OptiMedis AG, Hamburg, Germany
| | - Chiara Seghieri
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Milena Vainieri
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Italy
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14
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Wilasang C, Modchang C, Lincharoen T, Chadsuthi S. Estimation of Excess All-Cause Mortality Due to COVID-19 in Thailand. Trop Med Infect Dis 2022; 7:tropicalmed7070116. [PMID: 35878128 PMCID: PMC9322618 DOI: 10.3390/tropicalmed7070116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 01/27/2023] Open
Abstract
Thailand has experienced the most prominent COVID-19 outbreak in 2021, resulting in a new record for COVID-19 cases and deaths. To assess the influence of the COVID-19 outbreak on mortality, we estimated excess all-cause and pneumonia mortality in Thailand during the COVID-19 outbreak from April to October 2021. We used mortality from the previous 5 years to estimate the baseline number of deaths using generalized linear mixed models. The models were adjusted for seasonality and demographics. We found that, during the outbreak in 2021, there was a significant rise in excess fatalities, especially in the older age groups. The estimated cumulative excess death was 14.3% (95% CI: 8.6–18.8%) higher than the baseline. The results also showed that the excess deaths in males were higher than in females by approximately 26.3%. The excess deaths directly caused by the COVID-19 infections accounted for approximately 75.0% of the all-cause excess deaths. Furthermore, excess pneumonia deaths were also found to be 26.2% (95% CI: 4.8–46.0%) above baseline.
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Affiliation(s)
- Chaiwat Wilasang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
| | - Charin Modchang
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
- Centre of Excellence in Mathematics, MHESI, Bangkok 10400, Thailand
- Thailand Center of Excellence in Physics, Ministry of Higher Education, Science, Research and Innovation, 328 Si Ayutthaya Road, Bangkok 10400, Thailand
| | - Thanchanok Lincharoen
- Biophysics Group, Department of Physics, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; (C.W.); (C.M.); (T.L.)
| | - Sudarat Chadsuthi
- Department of Physics, Research Center for Academic Excellence in Applied Physics, Faculty of Science, Naresuan University, Phitsanulok 65000, Thailand
- Correspondence:
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15
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Perotti P, Bertuccio P, Cacitti S, Deandrea S, Boschetti L, Dalle Carbonare S, Marguati S, Migliazza S, Porzio E, Riboli S, Cadum E, Cecconami L, Odone A. Impact of the COVID-19 Pandemic on Total and Cause-Specific Mortality in Pavia, Northern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116498. [PMID: 35682081 PMCID: PMC9180651 DOI: 10.3390/ijerph19116498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
The COVID-19 pandemic had an unfavorable impact on overall mortality in Italy, with the strongest consequences in northern Italy. Scant data are available on cause-specific mortality. This study aims at investigating the impact of the pandemic on the overall and cause-specific mortality in one province in northern Italy, Pavia. We linked individual-level administrative data (i.e., death certification and population data) from the Health Protection Agency (HPA) in Pavia province between 2015 and 2020. We computed age-standardized mortality rates (Italian population 2011) by cause, sex, and calendar year, and computed the rate ratio and the corresponding 95% confidence intervals to compare rates in 2020 versus 2015–2019. The 2020 excess total mortality in Pavia was 24% in men and 25% in women, reaching rates of 1272.6/100,000 and 1304.4/100,000, respectively. Significant excesses were found for infectious and parasitic diseases, excluding COVID-19 (about +30% in both sexes); respiratory system diseases (44% in men; 30% in women); and dementia and Alzheimer’s disease among men (24%). Reductions were reported for neoplasms (−14% in men); cerebrovascular diseases (−25% in men); and ischemic diseases (−13% in women), but also for transport accidents in men. COVID-19 was the third cause of death in both sexes with rates of 274.9/100,000 men (859 total deaths) and 213.9/100,000 women (758 total deaths). Excess mortality in Pavia was higher than Italy but lower than Lombardy. Increases in mortality from causes related to infectious and respiratory diseases can likely be explained by underdiagnosed deaths from COVID-19.
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Affiliation(s)
- Pietro Perotti
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (S.C.); (A.O.)
- Correspondence:
| | - Stefano Cacitti
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (S.C.); (A.O.)
| | - Silvia Deandrea
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Lorenza Boschetti
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Simona Dalle Carbonare
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Stefano Marguati
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Simona Migliazza
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Eleonora Porzio
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Simona Riboli
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Ennio Cadum
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Lorella Cecconami
- Health Protection Agency of Pavia (ATS Pavia), 27100 Pavia, Italy; (P.P.); (S.D.); (L.B.); (S.D.C.); (S.M.); (S.M.); (E.P.); (S.R.); (E.C.); (L.C.)
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (S.C.); (A.O.)
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16
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Alicandro G, Remuzzi G, Centanni S, Gerli A, La Vecchia C. Excess total mortality during the Covid-19 pandemic in Italy: updated estimates indicate persistent excess in recent months. LA MEDICINA DEL LAVORO 2022; 113:e2022021. [PMID: 35481574 PMCID: PMC9073760 DOI: 10.23749/mdl.v113i2.13108] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
Background: New releases of daily mortality data are available in Italy; the last containing data up to 31 January 2022. This study revises previous estimates of the excess mortality in Italy during the Covid-19 pandemic. Methods: Excess mortality was estimated as the difference between the number of registered deaths and the expected deaths. Expected deaths in March-December 2020, January-December 2021 and January 2022 were estimated separately by sex, through an over-dispersed Poisson regression model using mortality and population data for the period 2011-2019. The models included terms for calendar year, age group, a smooth function of week of the year and the natural logarithm of the population as offset term. Results: We estimated 99,334 excess deaths (+18.8%) between March and December 2020, 61,808 deaths (+9.5%) in 2021 and 4143 deaths (+6.1%) in January 2022. Over the whole pandemic period, 13,039 excess deaths (+10.2%) were estimated in the age group 25-64 years with most of the excess observed among men [10,025 deaths (+12.6%) among men and 3014 deaths (+6.3%) among women]. Conclusions: Up to 31 January 2022, over 165 thousand excess deaths were estimated in Italy, of these about 8% occurred among the working age population. Despite high vaccination uptake, excess mortality is still observed in recent months.
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Affiliation(s)
- Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
| | - Stefano Centanni
- Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy.
| | - Alberto Gerli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
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17
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Voci D, Fedeli U, Farmakis IT, Hobohm L, Keller K, Valerio L, Schievano E, Barbiellini Amidei C, Konstantinides SV, Kucher N, Barco S. Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area. Thromb Res 2022; 212:44-50. [PMID: 35219931 PMCID: PMC8858636 DOI: 10.1016/j.thromres.2022.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary embolism is a known complication of coronavirus disease 2019 (COVID-19). Epidemiological population data focusing on pulmonary embolism-related mortality is limited. METHODS Veneto is a region in Northern Italy counting 4,879,133 inhabitants in 2020. All ICD-10 codes from death certificates (1st January 2018 to 31st December 2020) were examined. Comparisons were made between 2020 (COVID-19 outbreak) and the average of the two-year period 2018-2019. All-cause, COVID-19-related and the following cardiovascular deaths have been studied: pulmonary embolism, hypertensive disease, ischemic heart disease, atrial fibrillation/flutter, and cerebrovascular diseases. RESULTS In 2020, a total of 56,412 deaths were recorded, corresponding to a 16% (n = 7806) increase compared to the period 2018-2019. The relative percentage increase during the so-called first and second waves was 19% and 44%, respectively. Of 7806 excess deaths, COVID-19 codes were reported in 90% of death certificates. The percentage increase in pulmonary embolism-related deaths was 27% (95%CI 19-35%), 1018 deaths during the year 2020, compared to 804 mean annual deaths in the period 2018-2019. This was more evident among men, who experience an absolute increase of 147 deaths (+45%), than in women (+67 deaths; +14%). The increase was primarily driven by deaths recorded during the second wave (+91% in October-December). An excess of deaths, particularly among men and during the second wave, was also observed for other cardiovascular diseases, notably hypertensive disease, atrial fibrillation, cerebrovascular disease, and ischemic heart disease. CONCLUSIONS We observed a considerable increase of all-cause mortality during the year 2020. This was mainly driven by COVID-19 and its complications. The relative increase in the number of pulmonary embolism-related deaths was more prominent during the second wave, suggesting a possible underdiagnosis during the first wave.
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Affiliation(s)
- Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Democritus University of Thrace, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Corresponding author at: Department of Angiology, University Hospital Zurich, Raemistrasse 100, RAE C 19, 8091 Zurich, Switzerland
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18
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Ramírez-Soto MC, Ortega-Cáceres G, Arroyo-Hernández H. Excess all-cause deaths stratified by sex and age in Peru: a time series analysis during the COVID-19 pandemic. BMJ Open 2022; 12:e057056. [PMID: 35273060 PMCID: PMC8914408 DOI: 10.1136/bmjopen-2021-057056] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In this study, we estimated excess all-cause deaths and excess death rates during the COVID-19 pandemic in 25 Peruvian regions, stratified by sex and age group. DESIGN Cross-sectional study. SETTING Twenty-five Peruvian regions with complete mortality data. PARTICIPANTS Annual all-cause official mortality data set from SINADEF (Sistema Informático Nacional de Defunciones) at the Ministry of Health of Peru for 2017-2020, disaggregated by age and sex. MAIN OUTCOME MEASURES Excess deaths and excess death rates (observed deaths vs expected deaths) in 2020 by sex and age (0-29, 30-39, 40-49, 50-59, 60-69, 70-79 and ≥80 years) were estimated using P-score. The ORs for excess mortality were summarised with a random-effects meta-analysis. RESULTS In the period between January and December 2020, we estimated an excess of 68 608 (117%) deaths in men and 34 742 (69%) deaths in women, corresponding to an excess death rate of 424 per 100 000 men and 211 per 100 000 women compared with the expected mortality rate. The number of excess deaths increased with age and was higher in men aged 60-69 years (217%) compared with women (121%). Men between the ages of 40 and 79 years experienced twice the rate of excess deaths compared with the expected rate. In eight regions, excess deaths were higher than 100% in men, and in seven regions excess deaths were higher than 70% in women. Men in eight regions and women in one region had two times increased odds of excess death than the expected mortality. There were differences in excess mortality according to temporal distribution by epidemiological week. CONCLUSION Approximately 100 000 excess all-cause deaths occurred in 2020 in Peru. Age-stratified excess death rates were higher in men than in women. There was strong excess in geographical and temporal mortality patterns according to region.
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Affiliation(s)
- Max Carlos Ramírez-Soto
- Centro de Investigación en Salud Publica, Facultad de Medicina Humana, Universidad San Martin de Porres, Lima, Peru
- Facultad de Ciencias de la Salud, Universidad Tecnológica del Peru, Lima, Peru
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19
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Grande E, Fedeli U, Pappagallo M, Crialesi R, Marchetti S, Minelli G, Iavarone I, Frova L, Onder G, Grippo F. Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:805. [PMID: 35055627 PMCID: PMC8776013 DOI: 10.3390/ijerph19020805] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 12/23/2022]
Abstract
Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015-2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015-2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.
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Affiliation(s)
- Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35132 Padova, Italy;
| | - Marilena Pappagallo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
| | - Roberta Crialesi
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
| | - Stefano Marchetti
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Ivano Iavarone
- Department of Environment and Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Luisa Frova
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy; (M.P.); (R.C.); (S.M.); (L.F.); (F.G.)
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20
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Alicandro G, Remuzzi G, Centanni S, Gerli A, La Vecchia C. Excess total mortality in 2021 in Italy was about one third of that observed in 2020. LA MEDICINA DEL LAVORO 2021; 112:414-421. [PMID: 34939614 PMCID: PMC8759051 DOI: 10.23749/mdl.v112i6.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023]
Abstract
Background: Italy was severely hit by the Covid-19 pandemic with an excess of around 90,000 total deaths in 2020. Comparable data in 2021 are needed for monitoring the effects of the interventions adopted to control its spread and reduce the burden. This study estimates the excess mortality in Italy in the first eight months of 2021, with a focus on the working age population. Methods: Excess mortality was estimated as difference between the number of registered deaths and the expected deaths. Expected deaths in March-December 2020 and January-August 2021 were estimated separately by sex, through an over-dispersed Poisson regression model using mortality and population data for the period 2011-2019 (before the Covid-19 outbreak). The models included terms for calendar year, age group, a smooth function of week of the year and the natural logarithm of the population as offset term. Results: In the first eight months of 2021, we estimated 34,599 excess deaths (+7.9% of the expected deaths), of these 3667 were among individuals of working age (25-64 years). In this age group, mortality was 8.2% higher than expected with higher excesses among men (2972 deaths, +10.7%) than women (695 deaths, +4.1%). Conclusions: The excess deaths in the first eight months of 2021 account for about one third of that registered in 2020. Current data indicate that around 5000 excess deaths are expected by the end of the year, leading to a total excess for 2021 of around 40 thousand deaths. Despite the absence of influenza in January-March 2021, a relevant excess was also observed among the working age population.
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Affiliation(s)
- Gianfranco Alicandro
- Department of Pathophysiology and Transplantaersità degli Studi di Milano, Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.
| | - Stefano Centanni
- Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Mi-lan, Italy.
| | - Alberto Gerli
- Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Mi-lan, Italy.
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
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21
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Qi S, Ngwa C, Morales Scheihing DA, Al Mamun A, Ahnstedt HW, Finger CE, Colpo GD, Sharmeen R, Kim Y, Choi HA, McCullough LD, Liu F. Sex differences in the immune response to acute COVID-19 respiratory tract infection. Biol Sex Differ 2021; 12:66. [PMID: 34930441 PMCID: PMC8686792 DOI: 10.1186/s13293-021-00410-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background Sex differences in COVID-19 are increasingly recognized globally. Although infection rates are similar between the sexes, men have more severe illness. The mechanism underlying these sex differences is unknown, but a differential immune response to COVID-19 has been implicated in several recent studies. However, how sex differences shape the immune response to COVID-19 remains understudied. Methods We collected demographics and blood samples from over 600 hospitalized patients diagnosed with COVID-19 from May 24th 2020 to April 28th, 2021. These patients were divided into two cohorts: Cohort 1 was further classified into three groups based on the severity of the disease (mild, moderate and severe); Cohort 2 patients were longitudinally followed at three time points from hospital admission (1 day, 7 days, and 14 days). MultiPlex and conventional ELISA were used to examine inflammatory mediator levels in the plasma in both cohorts. Flow cytometry was conducted to examine leukocyte responses in Cohort 2. Results There were more COVID+ males in the total cohort, and the mortality rate was higher in males vs. females. More male patients were seen in most age groups (in 10-year increments), and in most ethnic groups. Males with severe disease had significantly higher levels of pro-inflammatory cytokines (IL-6, IL-8, MCP-1) than females; levels of IL-8, GRO, sCD40L, MIP-1β, MCP-1 were also significantly higher in severe vs. mild or control patients in males but not in females. Females had significantly higher anti-inflammatory cytokine IL-10 levels at 14 days compared to males, and the level of IL-10 significantly increased in moderate vs. the control group in females but not in males. At 7 days and 14 days, males had significantly more circulating neutrophils and monocytes than females; however, B cell numbers were significantly higher in females vs. males. Conclusion Sex differences exist in hospitalized patients with acute COVID-19 respiratory tract infection. Exacerbated inflammatory responses were seen in male vs. female patients, even when matched for disease severity. Males appear to have a more robust innate immune response, and females mount a stronger adaptive immune response to COVID-19 respiratory tract infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00410-2.
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Affiliation(s)
- Shaohua Qi
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Conelius Ngwa
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Diego A Morales Scheihing
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Abdullah Al Mamun
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Hilda W Ahnstedt
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Carson E Finger
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Gabriela Delevati Colpo
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Romana Sharmeen
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Youngran Kim
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - HuiMahn A Choi
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Louise D McCullough
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Fudong Liu
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, 77030, USA.
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Wollschläger D, Gianicolo E, Blettner M, Hamann R, Herm-Stapelberg N, Schoeps M. Association of COVID-19 mortality with COVID-19 vaccination rates in Rhineland-Palatinate (Germany) from calendar week 1 to 20 in the year 2021: a registry-based analysis. Eur J Epidemiol 2021; 36:1231-1236. [PMID: 34897584 PMCID: PMC8665990 DOI: 10.1007/s10654-021-00825-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022]
Abstract
Vaccination is among the measures implemented by authorities to control the spread of the COVID-19 pandemic. However, real-world evidence of population-level effects of vaccination campaigns against COVID-19 are required to confirm that positive results from clinical trials translate into positive public health outcomes. Since the age group 80 + years is most at risk for severe COVID-19 disease progression, this group was prioritized during vaccine rollout in Germany. Based on comprehensive vaccination data from the German federal state of Rhineland-Palatinate for calendar week 1–20 in the year 2021, we calculated sex- and age-specific vaccination coverage. Furthermore, we calculated the proportion of weekly COVID-19 fatalities and reported SARS-CoV-2 infections formed by each age group. Vaccination coverage in the age group 80 + years increased to a level of 80% (men) and 75% (women). Increasing vaccination coverage coincided with a reduction in the age group’s proportion of COVID-19 fatalities. In multivariable logistic regression, vaccination coverage was associated both with a reduction in an age-group’s proportion of COVID-19 fatalities [odds ratio (OR) per 5 percentage points = 0.89, 95% confidence interval (CI) = 0.82–0.96, p = 0.0013] and of reported SARS-CoV-2 infections (OR per 5 percentage points = 0.82, 95% CI 0.76–0.88, p < 0.0001). The results are consistent with a protective effect afforded by the vaccination campaign against severe COVID-19 disease in the oldest age group.
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Affiliation(s)
- Daniel Wollschläger
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Lecce, Italy
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ruben Hamann
- Division of Vaccine Documentation, Cancer Registry Rhineland-Palatinate, Mainz, Germany
| | - Nils Herm-Stapelberg
- Division of Vaccine Documentation, Cancer Registry Rhineland-Palatinate, Mainz, Germany
| | - Melissa Schoeps
- Division of Vaccine Documentation, Cancer Registry Rhineland-Palatinate, Mainz, Germany
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23
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[Explaining the age-adjusted excess mortality with COVID-19-attributed deaths from January 2020 to July 2021]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:378-387. [PMID: 34862925 PMCID: PMC8643124 DOI: 10.1007/s00103-021-03465-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
Abstract
Hintergrund Unsicherheiten in der Todesursachencodierung erschweren die Bestimmung der durch COVID-19 verursachten Mortalität. Dagegen ist die altersadjustierte Übersterblichkeit ein robuster Indikator für Auswirkungen der COVID-19-Pandemie auf die öffentliche Gesundheit. Die Übersterblichkeit spiegelt neben COVID-19-Sterbefällen aber potenziell auch negative Folgen der Maßnahmen zur Pandemieeindämmung wider. Ziele Diese Studie prüft, ob es in Deutschland von 01/2020 bis 07/2021 eine Übersterblichkeit gab, die nicht durch COVID-19 erklärbar ist, sondern für indirekte Effekte gesundheitspolitischer Maßnahmen auf die Mortalität spricht. Methoden Übersterblichkeitstrends im Zeitraum von 01/2020 bis 07/2021, jeweils in den Bundesländern sowie in den Kreisen von Rheinland-Pfalz, wurden auf Konsistenz mit COVID-19 zugeschriebenen Sterbefällen geprüft. Die erwarteten monatlichen Sterbefälle wurden auf Basis der Daten von 2015 bis 2019 vorhergesagt. Dabei wurden die Bevölkerungsstruktur, Lufttemperatur, saisonale Influenzaaktivität sowie zyklische und langfristige Zeittrends berücksichtigt. Ergebnisse In 232/304 (76,3 %) Monat-Bundesland- bzw. in 607/684 (88,7 %) Monat-Kreis-Kombinationen lag die COVID-19 zugeschriebene Mortalität innerhalb der 95 %-Vorhersageintervalle für die Übersterblichkeit. Die Rangkorrelation zwischen Übersterblichkeit und COVID-19-attribuierter Mortalität betrug für die Bundesländer 0,42 (95 %-Konfidenzintervall [0,31; 0,53]) und für die Kreise 0,21 (95 %-Konfidenzintervall [0,13; 0,29]). Diskussion Die gute Übereinstimmung der räumlich-zeitlichen Übersterblichkeitsmuster mit den COVID-19 zugeschriebenen Sterbefällen ist konsistent mit der Annahme, dass die Maßnahmen zur Eindämmung der COVID-19-Pandemie zwischen 01/2020 und 07/2021 nicht wesentlich zur Übersterblichkeit in Deutschland beigetragen haben. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03465-z) enthalten.
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24
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von Cube M, Timsit JF, Kammerlander A, Schumacher M. Quantifying and communicating the burden of COVID-19. BMC Med Res Methodol 2021; 21:164. [PMID: 34376146 PMCID: PMC8353440 DOI: 10.1186/s12874-021-01349-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background An essential aspect of preventing further COVID-19 outbreaks and to learn for future pandemics is the evaluation of different political strategies, which aim at reducing transmission of and mortality due to COVID-19. One important aspect in this context is the comparison of attributable mortality. Methods We give a comprehensive overview of six epidemiological measures that are used to quantify COVID-19 attributable mortality (p-score, standardized mortality ratio, absolute number of excess deaths, per capita rate, z-score and the population attributable fraction). Results By defining the six measures based on observed and expected deaths, we explain their relationship. Moreover, three publicly available data examples serve to illustrate the interpretational strengths and weaknesses of the various measures. Finally, we give recommendation which measures are suitable for an evaluation of public health strategies against COVID-19. The R code to reproduce the results is available as online supplementary material. Conclusion The number of excess deaths should be always reported together with the population attributable fraction, the p-score or the standardized mortality ratio instead of a per capita rate. For a complete picture of COVID-19 attributable mortality, quantifying and communicating its relative burden also to a lay audience is of major importance. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01349-z.
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Affiliation(s)
- Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
| | - Jéan-Francois Timsit
- UMR 1137 IAME Inserm/Université Paris Diderot, 16 Rue Henri Huchard, 75018, Paris, France.,APHP Medical and Infectious Diseases ICU, Bichat Hospital, 46 Rue Henri Huchard, 75877, Paris, France
| | - Andreas Kammerlander
- Institute for Economics, Department of International Economic Policy, University of Freiburg, Rempartstraße 10 - 16, 79098, Freiburg, Germany
| | - Martin Schumacher
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
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25
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Dorrucci M, Minelli G, Boros S, Manno V, Prati S, Battaglini M, Corsetti G, Andrianou X, Riccardo F, Fabiani M, Vescio MF, Spuri M, Urdiales AM, Martina DM, Onder G, Pezzotti P, Bella A. Excess Mortality in Italy During the COVID-19 Pandemic: Assessing the Differences Between the First and the Second Wave, Year 2020. Front Public Health 2021; 9:669209. [PMID: 34336767 PMCID: PMC8322580 DOI: 10.3389/fpubh.2021.669209] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Abstract
COVID-19 dramatically influenced mortality worldwide, in Italy as well, the first European country to experience the Sars-Cov2 epidemic. Many countries reported a two-wave pattern of COVID-19 deaths; however, studies comparing the two waves are limited. The objective of the study was to compare all-cause excess mortality between the two waves that occurred during the year 2020 using nationwide data. All-cause excess mortalities were estimated using negative binomial models with time modeled by quadratic splines. The models were also applied to estimate all-cause excess deaths “not directly attributable to COVD-19”, i.e., without a previous COVID-19 diagnosis. During the first wave (25th February−31st May), we estimated 52,437 excess deaths (95% CI: 49,213–55,863) and 50,979 (95% CI: 50,333–51,425) during the second phase (10th October−31st December), corresponding to percentage 34.8% (95% CI: 33.8%–35.8%) in the second wave and 31.0% (95%CI: 27.2%–35.4%) in the first. During both waves, all-cause excess deaths percentages were higher in northern regions (59.1% during the first and 42.2% in the second wave), with a significant increase in the rest of Italy (from 6.7% to 27.1%) during the second wave. Males and those aged 80 or over were the most hit groups with an increase in both during the second wave. Excess deaths not directly attributable to COVID-19 decreased during the second phase with respect to the first phase, from 10.8% (95% CI: 9.5%–12.4%) to 7.7% (95% CI: 7.5%–7.9%), respectively. The percentage increase in excess deaths from all causes suggests in Italy a different impact of the SARS-CoV-2 virus during the second wave in 2020. The decrease in excess deaths not directly attributable to COVID-19 may indicate an improvement in the preparedness of the Italian health care services during this second wave, in the detection of COVID-19 diagnoses and/or clinical practice toward the other severe diseases.
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Affiliation(s)
- Maria Dorrucci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istitituto Superiore di Sanità, Rome, Italy
| | - Stefano Boros
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Statistical Service, Istitituto Superiore di Sanità, Rome, Italy
| | - Sabrina Prati
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, Rome, Italy
| | - Marco Battaglini
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, Rome, Italy
| | - Gianni Corsetti
- Division of Population Register, Demographic and Living Conditions Statistics, Italian National Institute of Statistics, Rome, Italy
| | - Xanthi Andrianou
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Del Manso Martina
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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