Health and Healthcare Variables Associated with Italy’s Excess Mortality during the First Wave of the COVID-19 pandemic: An Ecological Study

Abstract

BackgroundHealthcare factors have strongly influenced the propagation of COVID-19. The present 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 indicators measured at a provincial level.MethodsThe present ecological study concerns the raw number of deaths from Jan. 1 to Apr. 30, 2020 and the mean number of deaths in the same months of 2015 to 2019, per province. Information on socioeconomic factors and healthcare settings were extracted from the most recently updated databases on the ISTAT website. Two multilevel, multivariate models were constructed to test whether excess mortality was associated with the indicators across 107 provinces in Italy.ResultsOn linear multilevel, multivariate analysis, AIDS mortality rate (p-value <0.05) correlates positively with excess mortality, while a higher density of General Practitioners (number of GPs per 1,000 population) is associated with lower excess mortality (p-value <0.05). After controlling for the diffusion of COVID-19 in each province, the significance of GP density increases (p-value <0.001) and the rate of hospitalization in long-term care wards is positively associated (p-value <0.05) with excess mortality.ConclusionSome health and healthcare variables are strongly associated with excess mortality caused by COVID-19 in Italy and should be considered to implement mitigation policies and increase healthcare resilience.

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis

“…ED overcrowding is a major public health issue worldwide. It is unclear if the dramatic reduction recorded with non-urgent and less urgent triage codes contributed to excess mortality [12], especially regarding patients who did not seek urgent medical attention. However, no difference before and after the COVID-19 outbreak was found in Regional calls to emergency medical service (EMS) [13], if not an increase compared to the same period of the previous year [14] as confirmed by the findings of the present study (arrival by ambulance: 34.7% in 2020, 28.6% in 2019).…”