COVID-19 in Italy: An Analysis of Death Registry Data

Ciminelli, Gabriele; Garcia-Mandicó, Sílvia

doi:10.1093/pubmed/fdaa165

Cited by 85 publications

(83 citation statements)

References 2 publications

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“…In Italy, a study comparing different variables that analyzed the effect of COVID-19 on daily deaths per 100,000 people of all genders and ages showed 30% higher mortality in men compared to women, with this difference becoming notably more striking in those aged 60 years and older. Worldwide, it is estimated that twice as many men die due to COVID-19 than women, according to data from the European Center for Disease Prevention and Control [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

Josa-Laorden

Vieitez

Andreu

et al. 2021

JCM

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There is some evidence that male gender could have a negative impact on the prognosis and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of the present study was to compare the characteristics of coronavirus disease 2019 (COVID-19) between hospitalized men and women with confirmed SARS-CoV-2 infection. This multicenter, retrospective, observational study is based on the SEMI-COVID-19 Registry. We analyzed the differences between men and women for a wide variety of demographic, clinical, and treatment variables, and the sex distribution of the reported COVID-19 deaths, as well as intensive care unit (ICU) admission by age subgroups. This work analyzed 12,063 patients (56.8% men). The women in our study were older than the men, on average (67.9 vs. 65.7 years; p < 001). Bilateral condensation was more frequent among men than women (31.8% vs. 29.9%; p = 0.007). The men needed non-invasive and invasive mechanical ventilation more frequently (5.6% vs. 3.6%, p < 0.001, and 7.9% vs. 4.8%, p < 0.001, respectively). The most prevalent complication was acute respiratory distress syndrome, with severe cases in 19.9% of men (p < 0.001). In men, intensive care unit admission was more frequent (10% vs. 6.1%; p < 0.001) and the mortality rate was higher (23.1% vs. 18.9%; p < 0.001). Regarding mortality, the differences by gender were statistically significant in the age groups from 55 years to 89 years of age. A multivariate analysis showed that female sex was significantly and independently associated with a lower risk of mortality in our study. Male sex appears to be related to worse progress in COVID-19 patients and is an independent prognostic factor for mortality. In order to fully understand its prognostic impact, other factors associated with sex must be considered.

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Section: Discussionmentioning

confidence: 99%

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

Josa-Laorden

Vieitez

Andreu

et al. 2021

JCM

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“…Next, we included a measure of urbanisation (percentage share of urban population), as studies show that the transmission of COVID-19 is higher in urban centres because of the ease of transmission and contraction due to travel, connection to outside world and so on, and urbanisation relates to the nature of egalitarian processes associated with modernisation [ 18 ]. Finally, we included a measure of the share of the population aged >65 years in country c sourced from the WDI data platform because research shows that the fatality rate from COVID-19 rises sharply with age due to co-morbidities [ 19 ]. We use the past five-year average on each of these variables.…”

Section: Methodsmentioning

confidence: 99%

Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis

Vadlamannati

Cooray

Soysa

2021

Scand J Public Health

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Aims: The COVID-19 pandemic has led to a spate of studies showing a close connection between inequitable access to health care, welfare services and adverse outcomes from the pandemic. Others have argued that democratic governments have generally failed relative to more autocratic ones, simply because autocrats can make the hard choices required for stemming the spread of viruses. We address this question by asking whether more ‘egalitarian’ forms of democracy matter, given that they contain more equitable health-care access and societal infrastructure, such as social capital and trust. Methods: We use standard regression techniques, including instrumental variables analysis addressing endogeneity on COVID-19 testing and deaths data as of the end of May and beginning of September. We use novel data from the Varieties of Democracy Project on health-system equity and egalitarian democracy. Results: Our results suggest that more equitable access to health care increases testing rates and lowers the death rate from COVID-19. Broader egalitarian governance, measured as egalitarian democracy, however, shows the opposite effect. Thus, factors associated with health-care capacity to reach and treat matter more than broader societal factors associated with social capital and trust. The results are robust to alternative testing procedures, including instrumental variable technique for addressing potential endogeneity. Conclusions: Despite a great deal of public health focus on how equitable governance helps fight the adverse effects of so-called neoliberal pandemics, we find that broadly egalitarian factors have had the opposite effect on fighting COVID-19, especially when an equitable health system has been taken into account. Fighting disease, thus, might be more about the capacity of health systems rather than societal factors, such as trust in government and social capital.

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“…To do so, we follow closely the methodology that we developed in two companion papers. 10,15 Specifically, we rely on a differences-in-differences approach to estimate the dynamic effects on the mortality rate, using the year 2016 as counterfactual of what mortality would have been in absence of Covid-19. The choice of using the year 2016 follows from a visual inspection of the data (see Appendix Figure A1), but the results are robust to using mean 2015-2019 mortality as alternative counterfactual.…”

Section: Empirical Methodologymentioning

confidence: 99%

How Healthcare Congestion Increases Covid-19 Mortality: Evidence from Lombardy, Italy*

Ciminelli

Garcia-Mandicó

2020

Preprint

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BACKGROUND: The Covid-19 pandemic has caused generous and well-developed healthcare systems to collapse. This paper quantifies how much system congestion may have increased mortality rates, using distance to the ICU as a proxy for access to emergency care. METHODS: We match daily death registry data for almost 1,500 municipalities in Lombardy, Italy, to data on geographical location of all ICU beds in the region. We then analyze how system congestion increases mortality in municipalities that are far from the ICU through a differences-in-differences regression model. FINDINGS: We find that Covid-19 mortality is up to 60% higher in the average municipality -- which is 15 minutes driving away from the closest ICU -- than in a municipality with an ICU in town. This difference is larger in areas and in days characterized by an abnormal number of calls to the emergency line. INTERPRETATION: We interpret these results as suggesting that a sudden surge of critical patients may have congested the healthcare system, forcing emergency medical services to prioritize patients in the most proximate communities in order to maximize the number of lives saved. Through some back-of-the-envelope calculations, we estimate that Lombardy's death toll from the first Covid-19 outbreak could have been 25% lower had all municipalities had ready access to the ICU. Drawing a lesson from Lombardy's tale, governments should strengthen the emergency care response and palliate geographical inequalities to ensure that everyone in need can receive critical care on time during new outbreaks.

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COVID-19 in Italy: An Analysis of Death Registry Data

Cited by 85 publications

References 2 publications

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

Gender-Based Differences by Age Range in Patients Hospitalized with COVID-19: A Spanish Observational Cohort Study

Health-system equity, egalitarian democracy and COVID-19 outcomes: An empirical analysis

How Healthcare Congestion Increases Covid-19 Mortality: Evidence from Lombardy, Italy*

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