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How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

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  • Corrado Magnani

    (Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, and CPO-Piedmont, I-28100 Novara, Italy
    Covid19ita Study Group, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy)

  • Danila Azzolina

    (Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, and CPO-Piedmont, I-28100 Novara, Italy
    Covid19ita Study Group, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy)

  • Elisa Gallo

    (Covid19ita Study Group, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy
    Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy)

  • Daniela Ferrante

    (Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of Eastern Piedmont, Novara, and CPO-Piedmont, I-28100 Novara, Italy
    Covid19ita Study Group, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy)

  • Dario Gregori

    (Covid19ita Study Group, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy
    Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, I-35131 Padova, Italy)

Abstract

Objective: Overall mortality is a relevant indicator of the population burden during an epidemic. It informs on both undiagnosed cases and on the effects of health system disruption. Methods: We aimed at evaluating the extent of the total death excess during the COVID-19 epidemic in Italy. Data from 4433 municipalities providing mortality reports until April 15th, 2020 were included for a total of 34.5 million residents from all Italian regions. Data were analyzed by region, sex and age, and compared to expected from 2015–2019. Results: In both genders, overall mortality was stable until February 2020 and abruptly increased from March 1st onwards. Within the municipalities studied, 77,339 deaths were observed in the period between March 1st to April 15th, 2020, in contrast to the 50,822.6 expected. The rate ratio was 1.11 before age 60 and 1.55 afterwards. Both sexes were affected. The excess was greater in the regions most affected by COVID-19 but always exceeded the deaths attributed to COVID-19. The extrapolation to the total Italian population suggests an excess of 45,033 deaths in the study period, while the number of COVID–19 deaths was 21,046. Conclusion: Our paper shows a large death excess during the COVID-19 epidemic in Italy; greater than the number attributed to it. Possible causes included both the undetected cases and the disruption of the Health Service organization. Timely monitoring of overall mortality based on unbiased nationwide data is an essential tool for epidemic control.

Suggested Citation

  • Corrado Magnani & Danila Azzolina & Elisa Gallo & Daniela Ferrante & Dario Gregori, 2020. "How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy," IJERPH, MDPI, vol. 17(10), pages 1-11, May.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:10:p:3452-:d:358612
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    References listed on IDEAS

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    1. Andrew Aligne, C., 2016. "Overcrowding and mortality during the influenza pandemic of 1918: Evidence from US Army Camp A. A. Humphreys, Virginia," American Journal of Public Health, American Public Health Association, vol. 106(4), pages 642-644.
    2. Bianca Cox & Françoise Wuillaume & Herman Oyen & Sophie Maes, 2010. "Monitoring of all-cause mortality in Belgium (Be-MOMO): a new and automated system for the early detection and quantification of the mortality impact of public health events," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 55(4), pages 251-259, August.
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    Cited by:

    1. Emiliano Ceccarelli & Maria Dorrucci & Giada Minelli & Giovanna Jona Lasinio & Sabrina Prati & Marco Battaglini & Gianni Corsetti & Antonino Bella & Stefano Boros & Daniele Petrone & Flavia Riccardo &, 2022. "Assessing COVID-19-Related Excess Mortality Using Multiple Approaches—Italy, 2020–2021," IJERPH, MDPI, vol. 19(24), pages 1-13, December.
    2. Dorn, Florian & Lange, Berit & Braml, Martin & Gstrein, David & Nyirenda, John L.Z. & Vanella, Patrizio & Winter, Joachim & Fuest, Clemens & Krause, Gérard, 2023. "The challenge of estimating the direct and indirect effects of COVID-19 interventions – Toward an integrated economic and epidemiological approach," Economics & Human Biology, Elsevier, vol. 49(C).
    3. Francesco Addabbo & Massimo Giotta & Antonia Mincuzzi & Aldo Sante Minerba & Rosa Prato & Francesca Fortunato & Nicola Bartolomeo & Paolo Trerotoli, 2023. "No Excess of Mortality from Lung Cancer during the COVID-19 Pandemic in an Area at Environmental Risk: Results of an Explorative Analysis," IJERPH, MDPI, vol. 20(8), pages 1-16, April.
    4. Marina Giachino & Camille Beatrice G. Valera & Sabina Rodriguez Velásquez & Muriel Anna Dohrendorf-Wyss & Liudmila Rozanova & Antoine Flahault, 2020. "Understanding the Dynamics of the COVID-19 Pandemic: A Real-Time Analysis of Switzerland’s First Wave," IJERPH, MDPI, vol. 17(23), pages 1-17, November.

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