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Grippo F, Grande E, Maraschini A, Navarra S, Pappagallo M, Marchetti S, Crialesi R, Frova L, Orsi C, Simeoni S, Carinci A, Loreto G, Donfrancesco C, Lo Noce C, Palmieri L, Andrianou X, Urdiales AM, Onder G, Minelli G. Evolution of Pathology Patterns in Persons Who Died From COVID-19 in Italy: A National Study Based on Death Certificates. Front Med (Lausanne) 2021; 8:645543. [PMID: 33829025 PMCID: PMC8019728 DOI: 10.3389/fmed.2021.645543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: In Italy, during the first epidemic wave of 2020, the peak of coronavirus disease 2019 (COVID-19) mortality was reached at the end of March. Afterward, a progressive reduction was observed until much lower figures were reached during the summer, resulting from the contained circulation of SARS-CoV-2. This study aimed to determine if and how the pathological patterns of the individuals deceased from COVID-19 changed during the phases of epidemic waves in terms of: (i) main cause of death, (ii) comorbidities, and (iii) complications related to death. Methods: Death certificates of persons who died and tested positive for SARS-CoV-2, provided by the National Surveillance system, were coded according to ICD rev10. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Results: The percentage of COVID-19 deaths varied over time. It decreased in the downward phase of the epidemic curve (76.6 vs. 88.7%). In February-April 2020, hypertensive heart disease was mentioned as a comorbidity in 18.5% of death certificates, followed by diabetes (15.9% of cases), ischemic heart disease (13.1%), and neoplasms (12.1%). In May-September, the most frequent comorbidity was neoplasms (17.3% of cases), followed by hypertensive heart disease (14.9%), diabetes (14.8%), and dementia/Alzheimer's disease (11.9%). The most mentioned complications in both periods were pneumonia and respiratory failure with a frequency far higher than any other condition (78.4% in February-April 2020 and 63.7% in May-September 2020). Discussion: The age of patients dying from COVID-19 and their disease burden increased in the May-September 2020 period. A more serious disease burden was observed in this period, with a significantly higher frequency of chronic pathologies. Our study suggests better control of the virus' lethality in the second phase of the epidemic, when the health system was less burdened. Moreover, COVID-19 care protocols had been created in hospitals, and knowledge about the diagnosis and treatment of COVID-19 had improved, potentially leading to more accurate diagnosis and better treatment. All these factors may have improved survival in patients with COVID-19 and led to a shift in mortality to older, more vulnerable, and complex patients.
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Affiliation(s)
- Francesco Grippo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Enrico Grande
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | | | - Simone Navarra
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Marilena Pappagallo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Stefano Marchetti
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Roberta Crialesi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Luisa Frova
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Chiara Orsi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Silvia Simeoni
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | | | - Giuseppe Loreto
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Xanthi Andrianou
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
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Grippo F, Navarra S, Orsi C, Manno V, Grande E, Crialesi R, Frova L, Marchetti S, Pappagallo M, Simeoni S, Di Pasquale L, Carinci A, Donfrancesco C, Lo Noce C, Palmieri L, Onder G, Minelli G. The Role of COVID-19 in the Death of SARS-CoV-2-Positive Patients: A Study Based on Death Certificates. J Clin Med 2020; 9:E3459. [PMID: 33121176 PMCID: PMC7692219 DOI: 10.3390/jcm9113459] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30-59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.
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Affiliation(s)
- Francesco Grippo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Simone Navarra
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Chiara Orsi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Enrico Grande
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Roberta Crialesi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Luisa Frova
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Stefano Marchetti
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Marilena Pappagallo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Silvia Simeoni
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Lucilla Di Pasquale
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Annamaria Carinci
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
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