Abstract
Although previous evidence suggests that the infection fatality rate from COVID-19 varies by age and sex, and that transmission intensity varies geographically within countries, no study has yet explored the age-sex-space distribution of excess mortality associated with the COVID pandemic. By applying the principles of small-area estimation to existing model formulations for excess mortality, this study develops a novel method for assessing excess mortality across small populations and assesses the pattern of COVID excess mortality by province, year, week, age group, and sex in Italy from March through May 2020. We estimate that 53,200 excess deaths occurred across Italy during this time period, compared to just 35,500 deaths where COVID-19 was registered as the underlying cause of death. Out of the total excess mortality burden, 97% of excess deaths occurred among adults over age 60, and 68% of excess deaths were concentrated among adults over age 80. The burden of excess mortality was unevenly distributed across the country, with just three of Italy’s 107 provinces accounting for 32% of all excess mortality. This method for estimating excess mortality can be adapted to other countries where COVID-19 diagnostic capacity is still insufficient, and could be incorporated into public health rapid response systems.
Highlights
Previous evidence suggests that the infection fatality rate from COVID-19 varies by age and sex, and that transmission intensity varies geographically within countries, no study has yet explored the age-sex-space distribution of excess mortality associated with the COVID pandemic
The aggregated results from our model generally agreed with previous national studies on the timing and magnitude of excess deaths associated with the COVID-19 pandemic across Italy
At no point between June and August 2020 did the observed death count exceed the upper bound of the 95% uncertainty interval for baseline deaths: as a result, the remainder of this section will focus on excess mortality during the 13-week period from 26 February through 26 May 2020. During these 13 weeks, we estimate that 53,200 excess deaths (95% uncertainty interval 26,500–79,700) were associated with the COVID-19 pandemic, compared with 35,500 deaths registered with COVID-19 as the underlying cause during the same period
Summary
Previous evidence suggests that the infection fatality rate from COVID-19 varies by age and sex, and that transmission intensity varies geographically within countries, no study has yet explored the age-sex-space distribution of excess mortality associated with the COVID pandemic. Excess mortality analyses attempt to measure the net effect of a discontinuity, such as a COVID-19 outbreak, on all-cause mortality This is a two-step process: first, the investigator constructs an estimated baseline number of deaths expected during the period in question. Previous investigations have examined how excess mortality analysis can capture deaths caused by COVID-19 but attributed to other causes, as well the indirect mortality burden of the COVID-19 pandemic[8,16] This study explores another central issue for excess mortality estimation: how can we detect increases in mortality at the local level or across multiple age groups, where the expected number of baseline deaths in each subpopulation of interest is relatively low? Even at the national level, weekly estimates of COVID-19 excess mortality presented without uncertainty intervals can leave viewers confused about what constitutes a meaningful departure from the baseline
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