Abstract
BackgroundStandardized mortality surveillance data, capable of detecting variations in total mortality at population level and not only among the infected, provide an unbiased insight into the impact of epidemics, like COVID-19 (Coronavirus disease). We analysed the temporal trend in total excess mortality and deaths among positive cases of SARS-CoV-2 by geographical area (north and centre-south), age and sex, taking into account the deficit in mortality in previous months.MethodsData from the Italian rapid mortality surveillance system was used to quantify excess deaths during the epidemic, to estimate the mortality deficit during the previous months and to compare total excess mortality with deaths among positive cases of SARS-CoV-2. Data were stratified by geographical area (north vs centre and south), age and sex.ResultsCOVID-19 had a greater impact in northern Italian cities among subjects aged 75–84 and 85+ years. COVID-19 deaths accounted for half of total excess mortality in both areas, with differences by age: almost all excess deaths were from COVID-19 among adults, while among the elderly only one third of the excess was coded as COVID-19. When taking into account the mortality deficit in the pre-pandemic period, different trends were observed by area: all excess mortality during COVID-19 was explained by deficit mortality in the centre and south, while only a 16% overlap was estimated in northern cities, with quotas decreasing by age, from 67% in the 15–64 years old to 1% only among subjects 85+ years old.ConclusionsAn underestimation of COVID-19 deaths is particularly evident among the elderly. When quantifying the burden in mortality related to COVID-19, it is important to consider seasonal dynamics in mortality. Surveillance data provide an impartial indicator for monitoring the following phases of the epidemic, and may help in the evaluation of mitigation measures adopted.
Highlights
Standardized mortality surveillance data, capable of detecting variations in total mortality at population level and among the infected, provide an unbiased insight into the impact of epidemics, like COVID-19 (Coronavirus disease)
The paper aims to analyse the temporal trend in total excess mortality and COVID-19 deaths defined as deaths among subjects with microbiologically confirmed SARSCoV-2 reported to the Italian National Surveillance system [19]
The plot on the right shows the temporal trend in the proportion of excess deaths not reported as COVID-19 deaths
Summary
Standardized mortality surveillance data, capable of detecting variations in total mortality at population level and among the infected, provide an unbiased insight into the impact of epidemics, like COVID-19 (Coronavirus disease). The first COVID-19 cases in China were reported in December 2019, spreading quickly first to neighbouring countries like Japan and South Korea and, across Europe, including Italy. On the 13th of July, the WHO declared the COVID-19 outbreak a pandemic currently affecting 210 countries and a death toll of almost 600,000 deaths and around 13 million cases [1]. The COVID-19 epidemic has been unique from several points of view in Italy [3], starting well before other European countries, with over 200,000 cases reported and one of the highest fatality rates worldwide (from 0·3% in the 30–39 age group to 20·2% in the 80+ age group) and with males at greater risk [4, 5]. The epidemic had a heterogeneous geographical distribution, with northern Italy being hit hardest with 90% of the COVID-19 death toll [9]
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