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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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Scafato E, Gandin C, Ghirini S, Galluzzo L, Martire S, Di Pasquale L, Cuffari A. A survey on the early identification and brief intervention for hazardous and harmful alcohol consumption in primary health care: the European Alcohol Measures for Public Health Research Alliance (AMPHORA) project. Addict Sci Clin Pract 2013. [PMCID: PMC3766047 DOI: 10.1186/1940-0640-8-s1-a66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Scafato E, Gandin C, Patussi V, Codenotti T, Londi I, Ghirini S, Galluzzo L, Martire S, Di Pasquale L. Identificazione Precoce Intervento Breve (IPIB): the training program of the National Institute of Health--Italian National Health Service (ISS) on early identification and brief intervention on alcohol for primary health care professionals in Italy. Addict Sci Clin Pract 2013. [PMCID: PMC3766169 DOI: 10.1186/1940-0640-8-s1-a68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Scafato E, Ghirini S, Rossi A, Galluzzo L, Martire S, Di Pasquale L, Gandin C. Early detection and brief intervention for hazardous and harmful drinkers in primary health care in Italy: evaluation of the strategies, activities and experiences of the Istituto Superiore di Sanità (ISS). Addict Sci Clin Pract 2012. [PMCID: PMC3480114 DOI: 10.1186/1940-0640-7-s1-a30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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