Background: Italy was the first country outside China to experience the impact of the COVID-19 pandemic, which resulted in a significant health burden. This study presents an analysis of the excess mortality across the 107 Italian provinces, stratified by sex, age group, and period of the outbreak.
Methods: The analysis was performed using a two-stage interrupted time series design using daily mortality data for the period January 2015 - May 2020. In the first stage, we performed province-level quasi-Poisson regression models, with smooth functions to define a baseline risk while accounting for trends and weather conditions and to flexibly estimate the variation in excess risk during the outbreak. Estimates were pooled in the second stage using a mixed-effects multivariate meta-analysis.
Results: In the period 15 February - 15 May 2020, we estimated an excess of 47,490 (95% empirical confidence intervals: 43,984 to 50,362) deaths in Italy, corresponding to an increase of 29.5% (95%eCI: 26.8 to 31.9%) from the expected mortality. The analysis indicates a strong geographical pattern, with the majority of excess deaths occurring in northern regions, where few provinces experienced up to 800% increase during the peak in late March. There were differences by sex, age, and area both in the overall impact and in its temporal distribution.
Conclusions: This study offers a detailed picture of excess mortality during the first months of the COVID-19 pandemic in Italy. The strong geographical and temporal patterns can be related to implementation of lockdown policies and multiple direct and indirect pathways in mortality risk.
<p>On behalf of the Multi-Country Multi-City Collaborative (MCC) Research Network.</p>
<p>Background & Aim: Climate change is considered the most important environmental threat to human health. Substantial mortality and morbidity burden have been directly or indirectly attributed to climate-sensitive environmental stressors. However, limited quantitative evidence exists on how much of this burden can be attributed to man-made influences on climate. In this large health attribution study, we aimed at quantifying the proportion of excess heat-related mortality attributed to anthropogenic climate change in recent decades across 626 locations across 41 countries in various regions of the world included in MCC database.</p>
<p>Methods: We first estimated the location-specific heat-mortality associations through two-stage time-series analyses with quasi-Poisson regression with distributed lag non-linear models and multivariate multilevel meta-regression using observed data. We then quantified the heat-related excess mortality in each location using daily modelled series derived from historical (factual) and preindustrial control (counterfactual) simulations from 5 general circulation models (ISIMIP2b database) in the period between 1991 and 2019. We finally computed the proportion of heat-related excess mortality attributable to anthropogenic influences as the difference between the two scenarios, with associated measures of uncertainty.</p>
<p>Results: We found a steep increase in level of warming, expressed as the difference in annual average temperature between scenarios, with an average increase of 1.0&#176;C (from 0.7&#176;C&#160; to 1.2&#176;C) across the 626 locations between 1991 and 2019. Overall excess heat-mortality fractions of 1.92% [95% confidence interval: 0.41, 3.25] and 1.28% [0.20, 2.50] were estimated under the factual and counterfactual scenarios, respectively, with an overall difference of 0.76% [0.25,1.74]. This translates to 33% of historical heat-excess mortality that can be attributed to anthropogenic climate change. Larger proportions were found in North America (46%), Central America (47%), South America (43%), South Africa (48%), Middle-East Asia (61%), South East-Asia (50%) and Australia (42%), although highly imprecise in most of cases.</p>
<p>Conclusions: Our findings suggest that current warming driven by anthropogenic influences is already responsible for a considerable proportion of the heat-related mortality burden. These results stress the importance of strengthening current mitigation strategies to reduce further warming of the planet and related health impacts.</p>
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.