Mortality and Morbidity

Zylke, Jody W.; Bauchner, Howard

doi:10.1001/jama.2020.11761

Cited by 59 publications

(27 citation statements)

References 10 publications

(17 reference statements)

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“…Previous assessment on the health impact focused on excess in all-cause mortality, 8-10 an indicator that offers a quantification of the overall burden of the disease, accounting for both direct and indirect effects. 11 However, these analyses are limited to urban areas or used data aggregated by region, and they adopted relatively simple designs based on pre-post comparisons that do not account for temporal trends and variation in other risk factors such as weather.…”

Section: Introductionmentioning

confidence: 99%

Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time series analysis

Scortichini

Santos

Donato

et al. 2020

Preprint

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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.

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Section: Introductionmentioning

confidence: 99%

Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time series analysis

Scortichini

Santos

Donato

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Concerns about the SARS-CoV-2 pandemic have been raised due to its high infectiousness, demanding radical changes in the basic structure of our present society [12]. Social distancing campaigns and a strict quarantine were implemented in numerous countries in an attempt to contain the COVID-19 dissemination [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Notably, there has been changes in patient flow at the emergency departments during the pandemic, and decreased hospital admissions due to cardiovascular diseases where reported by Huet et al [15] in France, and Ebinger et al [16] in the United States. In addition, ER visits for evaluation of patients with respiratory diseases increased dramatically during this period and consequently played a major role defining strategies as well as on how resources should be allocated to meet these new demands [12,13].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis

et al. 2020

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Purpose Obstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID-19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center. Materials and methods After Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in "Pre-Covid" and "Post-Covid" groups based on the admission dates. Results A total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007). Conclusion During the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology.

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“…The overlap of vulnerable populations from COVID-19 and PM exposure makes the measurement of the pandemic impacts complex. Unlike the deaths attributed to COVID-19, all-cause mortality could be an accurate measurement to estimate the direct and indirect effects of the pandemic on deaths [25].…”

Section: Introductionmentioning

confidence: 99%

Vulnerability and Burden of All-Cause Mortality Associated with Particulate Air Pollution during COVID-19 Pandemic: A Nationwide Observed Study in Italy

et al. 2021

Toxics

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Background: Limited evidence is available on the health effects of particulate matter (PM including PM2.5 with an aerodynamic diameter ≤ 2.5 μm; PM10, ≤ 10 μm; PM2.5–10, 2.5–10 μm) during the pandemic of COVID-19 in Italy. The aims of the study were to examine the associations between all-cause mortality and PM in the pandemic period and compare them to the normal periods (2015–2019). Methods: We collected daily data regarding all-cause mortality (stratified by age and gender), and PM concentrations for 107 Italian provinces from 1 January 2015 to 31 May 2020. A time-stratified case-cross design with the distributed lag non-linear model was used to examine the association between PM and all-cause mortality. We also compared the counts and fractions of death attributable to PM in two periods. Results: Italy saw an increase in daily death counts while slight decreases in PM concentrations in pandemic period. Each 10 µg/m3 increase in PM was associated with much higher increase in daily all-cause mortality during the pandemic period compared to the same months during 2015–2019 (increased mortality rate: 7.24% (95%CI: 4.84%, 9.70%) versus 1.69% (95%CI: 1.12%, 2.25%) for PM2.5; 3.45% (95%CI: 2.58%, 4.34%) versus 1.11% (95%CI: 0.79%, 1.42%) for PM10; 4.25% (95%CI: 2.99%, 5.52%) versus 1.76% (95%CI: 1.14%, 2.38%) for PM2.5–10). The counts and fractions of deaths attributable to PM were higher in 2020 for PM2.5 (attributable death counts: 20,062 versus 3927 per year in 2015–2019; attributable fractions: 10.2% versus 2.4%), PM10 (15,112 versus 3999; 7.7% versus 2.5%), and PM2.5–10 (7193 versus 2303; 3.7% versus 1.4%). Conclusion: COVID-19 pandemic increased the vulnerability and excess cases of all-cause mortality associated with short-term exposure to PM2.5, PM2.5–10, and PM10 in Italy, despite a decline in air pollution level.

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Mortality and Morbidity

Cited by 59 publications

References 10 publications

Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time series analysis

Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time series analysis

COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis

Vulnerability and Burden of All-Cause Mortality Associated with Particulate Air Pollution during COVID-19 Pandemic: A Nationwide Observed Study in Italy

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