Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities

• Main Authors: Paola Michelozzi, Francesca de’Donato, Matteo Scortichini, Patrizio Pezzotti, Massimo Stafoggia, Manuela De Sario, Giuseppe Costa, Fiammetta Noccioli, Flavia Riccardo, Antonino Bella, Moreno Demaria, Pasqualino Rossi, Silvio Brusaferro, Giovanni Rezza, Marina Davoli
• Format: Article
• Language: English
• Published: BMC 2020-08-01
• Series: BMC Public Health
• Subjects: Surveillance system; Total excess mortality; COVID-19-related death; Mortality displacement; Demographic factors
• Online Access: http://link.springer.com/article/10.1186/s12889-020-09335-8

Abstract Background Standardized 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. Methods Data 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. Results COVID-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. Conclusions An 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 provides an impartial indicator for monitoring the following phases of the epidemic, and may help in the evaluation of mitigation measures adopted.