Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data.

OBJECTIVES: This study was to compare the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals. STUDY DESIGN: We retrospectively analysed data from the COVID-19 Italian integrated surveillance system (14 September 2020 to 17 October 2021). METHODS: We used multivariable Cox proportional hazards models to estimate the hazard ratio (HR) of infection and, among cases, the HRs of death, hospitalisation and subsequent admission to intensive care unit in non-Italian nationals relative to Italian nationals. Estimates were adjusted for differences in sociodemographic characteristics and in the week and region of diagnosis. RESULTS: Of 4,111,067 notified cases, 336,265 (8.2%) were non-Italian nationals. Compared with Italian nationals, non-Italians showed a lower incidence of SARS-CoV-2 infection (HR = 0.81, 95% confidence interval [CI]: 0.80-0.81). However, once diagnosed, they were more likely to be hospitalised (HR = 1.90, 95% CI: 1.87-1.92) and then admitted to intensive care unit (HR = 1.08, 95% CI: 1.04-1.13), with differences larger in those coming from countries with a lower human development index. Compared with Italian cases, an increased rate of death was observed in non-Italian cases from low-human development index countries (HR = 1.41, 95% CI: 1.23-1.62). The HRs of SARS-CoV-2 infection and severe outcomes slightly increased after the start of the vaccination campaign. CONCLUSIONS: Underdiagnosis and delayed diagnosis in non-Italian nationals could explain their lower incidence compared with Italians and, among cases, their higher probability to present clinical conditions leading to worse outcomes. Facilitating early access to vaccination, diagnosis and treatment would improve the control of SARS-CoV-2 transmission and health outcomes in this vulnerable group.

Epidemiological characteristics of COVID-19 cases in Italy: an analysis from a sex/gender perspective

The current study aims to describe the characteristics of the SARS-CoV-2 infection from the beginning of its spread in Italy, in February 2020, up to April 2021 across the tested positive cases in Italy. Global data strongly suggest that a sex/gender-based disparity exists, with men being at higher risk of SARS-CoV-2 infection, hospitalization, poor clinical outcomes and death due to the coronavirus disease 2019 (COVID-19). With this in mind, we focused on a sex/gender analysis, in order to better understand the role of sex/gender-related determinants in the outcome of COVID-19. We used rou-tinely collected data retrieved from the Italian National Surveillance System of confirmed SARS-CoV-2 infections. Data is collected and entered daily on a secure online platform by the 19 Italian Regions and the two Autonomous Prov-inces, and all the system is coordinated by the Italian National Institute of Health. In total, 4.027.075 cases occurred from February 2020 to April 2021, and were included in the analysis. Our results show that in Italy the numbers of SARS-CoV-2 infections are quite similar in women and men, even if some differences in ex-posure and outcomes between sexes are present. In par-ticular, the case fatality rate over 50 years of age is signifi-cantly higher in men than in women, with the difference increasing with age. These data further confirm the importance of the integration of a sex/gender analysis in future studies, thus enabling effective public health measures and gender-specific solutions. © 2022, Il Pensiero Scientifico Editore s.r.l. All rights reserved.