Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data

Abstract

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015–2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015–2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

Impact of the COVID-19 Pandemic on Total and Cause-Specific Mortality in Pavia, Northern Italy

“…Increased mortality from infectious and parasitic diseases other than COVID-19 that was observed in Pavia is consistent with other previous studies based on Lombardy data during the first pandemic wave, despite an overall decrease at national level [ 9 ]. The COVID-19 pandemic is probably associated with many of the fatalities that were classified as due to respiratory diseases, among which pneumonia was the most common cause of death.…”

“…The lack of medical personnel and resources [ 25 ] (but probably even health policy-makers’ suggestions to minimize the risk of infection among sanitary operators) is arguably the main cause of the increased mortality that was attributed to symptoms, signs, abnormal findings, and poorly defined causes, even if this only significantly affected women. Increases in mortality from dementia and Alzheimer’s disease have previously been reported in Lombardy, but also in other areas on an international level [ 9 , 26 , 27 ]. Investigations to specifically assess the possible psychological distress due to the pandemic (and possibly due to lockdown), as well as details regarding the significantly different results between the sexes are needed.…”

“…Regarding cause-specific mortality, in accordance with our results, a decrease in mortality that was caused by cardiovascular diseases and neoplasms was also reported [ 12 ]. Reductions in mortality from neoplasms emerged from national figures (−4.3%) during the first pandemic wave but were less evident from the data on Lombardy (−0.8%) [ 9 ].…”

“…The COVID-19 pandemic is probably associated with many of the fatalities that were classified as due to respiratory diseases, among which pneumonia was the most common cause of death. Patients with respiratory symptoms may not have been diagnosed as infected by the virus due to a lack of testing availability, or they may not have received the proper treatment for their medical conditions in the situation of emergency because of a lack of resources [ 9 , 24 ]. The lack of medical personnel and resources [ 25 ] (but probably even health policy-makers’ suggestions to minimize the risk of infection among sanitary operators) is arguably the main cause of the increased mortality that was attributed to symptoms, signs, abnormal findings, and poorly defined causes, even if this only significantly affected women.…”

“…Estimates of excess mortality from all causes are heterogeneous across the country with dramatic increases in northern geographical areas, but there remain no figures of net mortality in central and southern Italy. Figures are periodically updated by the Italian National Institute of Statistics (ISTAT) and the National Institute of Health (ISS), and several studies estimated the excess total mortality in Italy [ 8 , 9 , 10 , 11 ]. However, a few studies have been published on mortality data by specific cause of death [ 12 , 13 , 14 ].…”