Variation in excess all-cause mortality by age, sex, and province during the first wave of the COVID-19 pandemic in Italy
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Abstract
Although previous evidence suggests that the infection fatality rate from COVID-19 varies by age and sex, and that transmission intensity varies geographically within countries, no study has yet explored the age-sex-space distribution of excess mortality associated with the COVID pandemic. By applying the principles of small-area estimation to existing model formulations for excess mortality, this study develops a novel method for assessing excess mortality across small populations and assesses the pattern of COVID excess mortality by province, year, week, age group, and sex in Italy from March through May 2020. We estimate that 53,200 excess deaths occurred across Italy during this time period, compared to just 35,500 deaths where COVID-19 was registered as the underlying cause of death. Out of the total excess mortality burden, 97% of excess deaths occurred among adults over age 60, and 68% of excess deaths were concentrated among adults over age 80. The burden of excess mortality was unevenly distributed across the country, with just three of Italy’s 107 provinces accounting for 32% of all excess mortality. This method for estimating excess mortality can be adapted to other countries where COVID-19 diagnostic capacity is still insufficient, and could be incorporated into public health rapid response systems.
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SciScore for 10.1101/2021.07.14.21260494: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This method for measuring excess mortality also has several limitations that should be noted. Because the process for estimating baseline deaths is more complicated and requires additional inputs compared to a simpler averaging method, it is less accessible to a wide range of users. The model for estimating baseline mortality assumes the same relationship between each covariate and mortality across age groups. In reality, some …
SciScore for 10.1101/2021.07.14.21260494: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This method for measuring excess mortality also has several limitations that should be noted. Because the process for estimating baseline deaths is more complicated and requires additional inputs compared to a simpler averaging method, it is less accessible to a wide range of users. The model for estimating baseline mortality assumes the same relationship between each covariate and mortality across age groups. In reality, some covariates may have a differential effect by age—for example, temperature may have more of an impact on mortality in older age groups due to the greater prevalence of risk factors that inhibit the body’s thermoregulatory response20,21. This limitation is partly addressed by the separate harmonic seasonality fits for each age group. This study is also limited to the set of covariates which can be estimated by province and year: other covariates that may be predictive of all-cause mortality, such as the prevalence of environmental and occupational risk factors, were excluded due to lack of availability at the province level. While the population groupings reported in this study could be divided into even more granular units, any small-area investigation must protect the privacy rights of individuals22. Finally, as described in the Introduction, findings from excess mortality analyses must be carefully interpreted due to the many possible sources for changing mortality which are not accounted for in the modeling strategy. Additional mechanisms for public h...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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