Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, via Cristoforo Colombo, 112, 00147, Rome, Italy.
National Health Institute, Viale Regina Elena, 299, 00161, Rome, Italy.
BMC Public Health. 2020 Aug 14;20(1):1238. doi: 10.1186/s12889-020-09335-8.
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.
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.
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.
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.
标准化死亡率监测数据能够在人群水平上检测总死亡率的变化，而不仅仅是在感染者中，为评估像 COVID-19（冠状病毒病）这样的传染病的影响提供了无偏见的视角。我们分析了 SARS-CoV-2 阳性病例的总超额死亡率和死亡人数随地理区域（北部和中南部）、年龄和性别变化的趋势，同时考虑了前几个月的死亡率不足。
使用意大利快速死亡率监测系统的数据来量化疫情期间的超额死亡人数，估计前几个月的死亡率不足，并将总超额死亡率与 SARS-CoV-2 阳性病例的死亡人数进行比较。数据按地理区域（北部与中南部）、年龄和性别进行分层。
COVID-19 在北部意大利城市的 75-84 岁和 85 岁以上人群中影响更大。COVID-19 死亡人数占两个地区总超额死亡人数的一半，且按年龄存在差异：几乎所有的超额死亡都是 COVID-19 导致的，而在老年人中，只有三分之一的超额死亡被归类为 COVID-19。考虑到大流行前时期的死亡率不足，不同地区的趋势也不同：COVID-19 期间的所有超额死亡都可以用中南部的死亡率不足来解释，而在北部城市，估计只有 16%的重叠，且随着年龄的增长，死亡率下降，从 15-64 岁的 67%降至 85 岁以上人群的 1%。
老年人中 COVID-19 死亡人数的低估尤其明显。在量化与 COVID-19 相关的死亡率负担时，考虑季节性死亡率动态非常重要。监测数据为监测疫情的后续阶段提供了公正的指标，并可能有助于评估所采取的缓解措施。
