ORIGINAL ARTICLE   

Minerva Cardiology and Angiology 2022 April;70(2):160-6

DOI: 10.23736/S2724-5683.20.05349-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Excess all-cause mortality during COVID-19 outbreak: potential role of untreated cardiovascular disease

Andrea SAGLIETTO ¹ ✉, Fabrizio D’ASCENZO ¹, Elena CAVARRETTA ^{2, 3}, Giacomo FRATI ^{2, 4}, Matteo ANSELMINO ¹, Francesco VERSACI ⁵, Giuseppe BIONDI-ZOCCAI ^{2, 3}, Gaetano M. DE FERRARI ¹

¹ Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy; ² Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; ³ Mediterranea Cardiocentro, Naples, Italy; ⁴ IRCCS NEUROMED, Pozzilli, Isernia, Italy; ⁵ Unit of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has rapidly spread globally. Due to different testing strategies, under-detection of positive subjects and COVID-19-related-deaths remains common. Aim of this analysis was to assess the real impact of COVID-19 through the analysis of 2020 Italian all-cause mortality data compared to historical series.
METHODS: We performed a retrospective analysis of 2020 and 2015-2019 all-cause mortality data released by the Italian National Institute for Statistics (ISTAT) for the time period January 1^st-March 21^st. This preliminary sample included 1084 Italian municipalities showing at least 10 deaths during the above-mentioned timeframe and an increase in mortality of more than 20% as compared to the previous five years (2015-2019), with a resulting coverage of 21% of Italian population. The difference between 2020 observed and expected deaths (mean of weekly deaths in 2015-2019) was computed, together with mortality rate ratio (MRR) for each of the four weeks following detection of the first autochthonous COVID-19 case in Italy (February 23^rd, 2020 - March 21^st, 2020), as well as for this entire timeframe. Subgroup analysis by age groups was also performed.
RESULTS: Overall MRR was 1.79 [1.75-1.84], with an observed excess mortality of 8750 individuals in the investigated sample, which in itself outweighs Italian Civil Protection report of only 4,825 COVID-19-related deaths across Italy, as of March 21. Subgroup analysis did not show any difference in mortality rate in ‘0-14 years’ age group, while MRRs were significantly increased in older age groups, in particular in patients >75 years (MRR 1.84 [1.79-1.89]). In addition, week-by-week analysis showed a progressive increase in MRR during this period, peaking in the last week (March 15^th, 2020 - March 21^st, 2020) with an estimated value of 2.65 [2.53-2.78].
CONCLUSIONS: The analysis of all-cause mortality data in Italy indicates that reported COVID-19-related deaths are an underestimate of the actual death toll. All-cause death should be seen as the epidemiological indicator of choice to assess the real mortality impact exerted by SARS-CoV-2, given that it also best reflects the toll on frail patient subsets (e.g. the elderly or those with cardiovascular disease).

KEY WORDS: COVID-19; Mortality; Italy