General and COVID-19-related mortality by pre-existing chronic conditions and care setting during 2020 in Emilia-Romagna region, Italy (preprint)

Background: in the 2020, the number of deaths increased substantially in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims at quantifying excess mortality variability over time and in relation to demographic and pre-existent chronic conditions and care setting in Emilia-Romagna region, Italy. Methods registry-based study, comparing the 2020 observed mortality with the figures of the previous 5 years by age, sex, month, place of death, and pre-existing chronic conditions and including 300 094 deaths referred to 18+ aged people resident in Emilia-Romagna region (Northern Italy). Results excess deaths were higher during the first pandemic wave, particularly among man in March. Age-adjusted risk was similar among both men and women (Mortality Rate Ratio 1.15; IC95% 1.14-1.16). The risk of dying was sensibly higher among females aged 75+ years, in Long-term Care Facilities and at home. Excluding COVID-19 related deaths, differences in the risk of dying estimates tended to disappear. Metabolic and neuropsychiatric diseases were more prevalent among those deceased in 2020 compared to the deaths occurred in 2015-19. Conclusions no particular differences of risk by sex and age were found, despite the heterogeneity of the effect in relation to the sub-periods. Metabolic and neuropsychiatric diseases have been confirmed as elements of increased frailty, such as being in Long-term Care Facilities or private home as place of death. Understanding the impact of the pandemic on overall mortality is relevant in a changing scenario.

Monitoring the indirect impact of Covid-19 on hospital care pathways in Italy: results from the Mimico-19 network (preprint)

The COVID-19 pandemic has a non-negligible indirect impact on hospital care pathways, which is important to estimate. To this aim, we set up the Mimico-19 network of seven Italian regions (62% of the Italian population) representing different socio-demographic areas of the country with also a different burden of the epidemic. We retrospectively analysed regional hospital discharges data, computing twelve indicators of volumes and performance in three clinical areas: cardiology, oncology and orthopaedics, including time-dependent pathways and elective surgery. Weekly indicators for the period January-July 2020 were compared with the average of the corresponding indicators in 2018 and 2019; comparisons were performed within 3 sub-periods: pre-lockdown, lockdown and post-lockdown. The weekly trend of hospitalizations for ST-segment elevation myocardial infarction (STEMI) showed a 40% reduction, but the proportion of STEMI patients with a primary PTCA did not significantly change from previous years. Volumes of malignant neoplasms surgeries differed substantially by site, with a limited reduction for lung cancer (<20%) and greater declines (30-40%) for breast and prostate cancers. Hospitalizations for femoral neck fracture in the elderly decreased by 20%, but the percentage of timely interventions remained constantly higher than the previous years. General trends did not show important differences across regions, regardless of the different Covid-19 burden. Hospitalizations have generally decreased, but the capacity of a timely and effective response in time-dependent pathways of care was not jeopardized throughout the period. The drop in the care demand for cardiovascular diseases and cancers needs to be further investigated and monitored more thoroughly.