Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany.
Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Lecce, Italy.
Eur J Epidemiol. 2021 Feb;36(2):213-218. doi: 10.1007/s10654-021-00717-9. Epub 2021 Jan 25.
Since the beginning of the COVID-19 pandemic, data have been accumulated to examine excess mortality in the first half of 2020. Mortality in the preceding year or years is used to calculate the expected number of deaths, which is then compared with the actual number of deaths in 2020. We calculated weekly age- and sex-specific mortality rates for 93.1% of the Italian municipalities for the years 2015-2019 and for the first 26 weeks in 2020. We assumed the mortality experience during 2015-2019 as the reference period to calculate standardised mortality ratios. Furthermore, in order to compare the mortality experience of males and females, we calculated sex- and age- specific weekly direct standardised mortality rates and differences between the observed and expected number of deaths. We observed considerable changes in the demographics in the Italian population between the years 2015 and 2020, particularly among people 60 years and older and among males. The population is aging and the proportion of elderly males has increased, which was not reflected adequately in previous estimates of excess mortality. Standardized excess mortality results show that in Italy between the 8th and 26th weeks in 2020, there were 33,035 excess deaths, which is only 643 fewer deaths than the official COVID-19 death toll for this time period. A comparative increase in the mortality rates was observed in March among both sexes, but particularly for males. Comparisons with recently published data show considerably higher excess deaths, but these data were either not covering the complete country or did not account for age and sex. Neglecting the demographic changes in a region, even over a short time span, can result in biased estimates.
自 COVID-19 大流行开始以来，已经积累了数据来检查 2020 年上半年的超额死亡率。前一年或几年的死亡率用于计算预期死亡人数，然后将其与 2020 年的实际死亡人数进行比较。我们计算了 2015-2019 年意大利 93.1%的市镇的年龄和性别特异性每周死亡率，以及 2020 年的前 26 周。我们假设 2015-2019 年的死亡率经历作为参考期来计算标准化死亡率比。此外，为了比较男性和女性的死亡率经历，我们计算了性别和年龄特异性每周直接标准化死亡率以及观察到的和预期的死亡人数之间的差异。我们观察到 2015 年至 2020 年间意大利人口的人口结构发生了相当大的变化，特别是在 60 岁及以上的人群和男性中。人口老龄化，老年男性的比例增加，这在以前对超额死亡率的估计中没有得到充分反映。标准化超额死亡率结果表明，2020 年 2 月至 26 周期间，意大利有 33035 人超额死亡，比同期官方 COVID-19 死亡人数仅少 643 人。两性的死亡率在 3 月都观察到了比较性的增加，但男性尤其明显。与最近公布的数据进行比较显示，超额死亡人数要高得多，但这些数据要么没有涵盖整个国家，要么没有考虑年龄和性别。即使在短时间内忽略一个地区的人口变化，也可能导致有偏差的估计。
