Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 23;49(6):1909-1917.
doi: 10.1093/ije/dyaa169.

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

Matteo Scortichini  1   2 , Rochelle Schneider Dos Santos  1   3 , Francesca De' Donato  2 , Manuela De Sario  2 , Paola Michelozzi  2 , Marina Davoli  2 , Pierre Masselot  1 , Francesco Sera  1 , Antonio Gasparrini  1   3   4
Affiliations

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

Matteo Scortichini et al. Int J Epidemiol. .

Abstract

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 (eCIs): 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 increases up to 800% during the peak in late March. There were differences by sex, age and area both in the overall impact and in its temporal distribution.

Conclusion: 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 the implementation of lockdown policies and multiple direct and indirect pathways in mortality risk.

Keywords: COVID-19; Italy; SARS-CoV-2; epidemic; interrupted time series; mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Maps of percentage excess in mortality during the intense period of the COVID-19 pandemic (15 February–15 May 2020) by province in Italy, in total and stratified by sex and age group
Figure 2
Figure 2
Percentage excess in mortality (with 95% empirical confidence intervals) during the intense period of the COVID-19 pandemic (15 February–15 May 2020) in Italy, in total and stratified by sex and age group
Figure 3
Figure 3
Trend in excess risk (relative risk, RR) during the period 1 February–15 May 2020 in Italy by sex, age and geographical area compared with the total (with a band corresponding to the 95% empirical confidence intervals)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Onder G, Rezza G, Brusaferro S.. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020;323:1775–6. - PubMed
    1. Guan W, Ni Z, Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20. - PMC - PubMed
    1. John Hopkins University. Covid-19 dashboard. https://coronavirus.jhu.edu/map.html (26 June 2020, date last accessed).
    1. Department for Civil Protection. [COVID-19 Italy: regional data digital repository]. 2020. https://github.com/pcm-dpc/COVID-19/tree/master/dati-regioni (26 June 2020, date last accessed).
    1. Italian Government—Presidency of the Council of Ministers. #IoRestoaCasa, measures for containment and management of the COVID-19 epidemiological emergency. http://www.governo.it/it/iorestoacasa-misure-governo (26 June 2020, date last accessed).

Publication types