Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Via Loredan, 18, Padova 35131, Italy.
Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, Padova 35131, Italy.
Health Policy. 2022 Apr;126(4):294-301. doi: 10.1016/j.healthpol.2022.03.002. Epub 2022 Mar 8.
Healthcare factors have strongly influenced the propagation of COVID-19. This study aims to examine whether excess mortality during the first phase of the COVID-19 outbreak in Italy was associated with health, healthcare, demographic, and socioeconomic, provincial-level indicators.
This ecological study concerns the raw number of deaths reported from February 1 to April 30, 2020 and the mean number of deaths occurred during the same months from 2015 to 2019, per province. Information on socioeconomic factors and healthcare settings was extracted from updated databases on the Italian National Institute of Statistics (ISTAT) website. A multivariate model and four multilevel models were constructed to test the association between excess mortality and the analysed indicators across 107 Italian provinces.
The hospitalization rate in long-term care wards and the cardiovascular disease mortality rate correlate positively with excess mortality (p <0.05), while higher densities of licensed physicians and of general practitioners are associated with lower excess mortality (p <0.05). After controlling for the COVID-19 cumulative incidence in each province, only the density of licensed physicians remains negatively associated with excess mortality (p <0.01).
Some health and healthcare variables (in particular, the density of physicians) are strongly associated with excess mortality during the first wave of the COVID-19 pandemic in Italy and should be targeted to increase the resilience of health systems.
医疗保健因素强烈影响了 COVID-19 的传播。本研究旨在检验意大利 COVID-19 爆发初期的超额死亡率是否与健康、医疗保健、人口统计学和社会经济、省级指标有关。
本生态研究涉及 2020 年 2 月 1 日至 4 月 30 日报告的死亡人数的原始数量和 2015 年至 2019 年同期每个省的平均死亡人数。社会经济因素和医疗保健环境的信息从意大利国家统计局（ISTAT）网站上的更新数据库中提取。构建了一个多变量模型和四个多水平模型，以检验 107 个意大利省份的超额死亡率与分析指标之间的关联。
长期护理病房的住院率和心血管疾病死亡率与超额死亡率呈正相关（p<0.05），而执业医师和全科医生的密度较高与超额死亡率较低相关（p<0.05）。在控制每个省份 COVID-19 的累积发病率后，只有执业医师的密度与超额死亡率呈负相关（p<0.01）。
一些健康和医疗保健变量（特别是医生的密度）与意大利 COVID-19 大流行第一波期间的超额死亡率密切相关，应针对这些变量提高卫生系统的弹性。
