A population-based cohort approach to assess excess mortality due to the spread of COVID-19 in Italy, January-May 2020.

IF 1.1 4区医学 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Annali dell'Istituto superiore di sanita Pub Date : 2022-01-01 DOI:10.4415/ANN_22_01_04

Maria Dorrucci, Giada Minelli, Stefano Boros, Valerio Manno, Sabrina Prati, Marco Battaglini, Gianni Corsetti, Xanthi Andrianou, Flavia Riccardo, Massimo Fabiani, Maria Fenicia Vescio, Matteo Spuri, Alberto Mateo-Urdiales, Martina Del Manso, Patrizio Pezzotti, Antonino Bella

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引用次数: 1

Abstract

Aims: To assess the impact of the COVID-19 pandemic on all-cause mortality in Italy during the first wave of the epidemic, taking into consideration the geographical heterogeneity of the spread of COVID-19.

Methods: This study is a retrospective, population-based cohort study using national statistics throughout Italy. Survival analysis was applied to data aggregated by day of death, age groups, sex, and Italian administrative units (107 provinces). We applied Cox models to estimate the relative hazards (RH) of excess mortality, comparing all-cause deaths in 2020 with the expected deaths from all causes in the same time period. The RH of excess deaths was estimated in areas with a high, moderate, and low spread of COVID-19. We reported the estimate also restricting the analysis to the period of March-April 2020 (first peak of the epidemic).

Results: The study population consisted of 57,204,501 individuals living in Italy as of January 1, 2020. The number of excess deaths was 36,445, which accounts for 13.4% of excess mortalities from all causes during January-May 2020 (i.e., RH = 1.134; 95% confidence interval (CI): 1.129-1.140). In the macro-area with a relatively higher spread of COVID-19 (i.e., incidence rate, IR): 450-1,610 cases per 100,000 residents), the RH of excess deaths was 1.375 (95% CI: 1.364-1.386). In the area with a relatively moderate spread of COVID-19 (i.e., IR: 150-449 cases) it was 1.049 (95% CI: 1.038-1.060). In the area with a relatively lower spread of COVID-19 (i.e., IR: 30-149 cases), it was 0.967 (95% CI: 0.959-0.976). Between March and April (peak months of the first wave of the epidemic in Italy), we estimated an excess mortality from all causes of 43.5%. The RH of all-cause mortality for increments of 500 cases per 100,000 residents was 1.352 (95% CI: 1.346-1.359), corresponding to an increase of about 35%.

Conclusions: Our analysis, making use of a population-based cohort model, estimated all-cause excess mortality in Italy taking account of both time period and of COVID-19 geographical spread. The study highlights the importance of a temporal/geographic framework in analyzing the risk of COVID-19-epidemy related mortality.

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基于人群的队列方法评估2020年1月至5月意大利COVID-19传播造成的超额死亡率

目的:考虑到COVID-19传播的地理异质性，评估COVID-19大流行对意大利第一波疫情期间全因死亡率的影响。方法:本研究是一项回顾性的、基于人群的队列研究，采用意大利全国统计数据。生存分析应用于按死亡日期、年龄组、性别和意大利行政单位(107个省)汇总的数据。我们应用Cox模型来估计超额死亡率的相对危险度(RH)，并将2020年的全因死亡与同期的全因预期死亡进行比较。在COVID-19高、中、低传播地区估计了超额死亡的相对RH。我们报告的估计还将分析限制在2020年3月至4月期间(流行病的第一个高峰)。结果:截至2020年1月1日，研究人群包括居住在意大利的57,204,501人。超额死亡人数为36 445人，占2020年1月至5月期间所有原因造成的超额死亡人数的13.4%(即相对死亡率= 1.134;95%置信区间(CI): 1.129-1.140)。在COVID-19传播相对较高的宏观地区(即发病率，IR):每10万居民450-1,610例)，超额死亡的相对危险度为1.375 (95% CI: 1.364-1.386)。在COVID-19传播相对温和的地区(即IR: 150-449例)，该指数为1.049 (95% CI: 1.038-1.060)。在COVID-19传播相对较低的地区(即IR: 30-149例)，该指数为0.967 (95% CI: 0.959-0.976)。在3月至4月(意大利第一波疫情的高峰月份)期间，我们估计所有原因造成的超额死亡率为43.5%。每10万居民增加500例，全因死亡率的相对危险度为1.352 (95% CI: 1.346-1.359)，相应增加约35%。结论:我们的分析使用基于人群的队列模型，在考虑到时间和COVID-19地理传播的情况下，估计了意大利的全因超额死亡率。该研究强调了时间/地理框架在分析covid -19流行病相关死亡风险方面的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annali dell'Istituto superiore di sanita PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

3.80

自引率

4.80%

发文量

审稿时长

>12 weeks

期刊介绍： Annali dell’Istituto Superiore di Sanità is a peer reviewed quarterly science journal which publishes research articles in biomedicine, translational research and in many other disciplines of the health sciences. The journal includes the following material: original articles, reviews, commentaries, editorials, brief and technical notes, book reviews. The publication of Monographic Sections has been discontinued. In case you wish to present a small number of coordinated contributions on specific themes concerning priorities in public health, please contact the Editorial office. The journal is in English.