Higher Death Rates in the Italian COVID-19 Outbreak: A Comparative Modelling Analysis of 8,342 Italy and 44,672 China Cases
11 Pages Posted: 31 Mar 2020More...
Background: Italy is undergoing an unprecedented COVID-1 epidemic - one of the largest and most lethal outbreaks outside China. The higher death rate observed compared to China COVID-19 raises concern regarding the evolution of the Epidemic. We conducted a comparative analysis of age-specific deaths in COVID-19 patients in Italy and compared them with those reported form the China.
Methods: Data on confirmed of 8,342 COVID-19 cases from Italy and 46,672 from China were analysed using stratified analyses by Cochran–Mantel–Haenszel statistics. A logistic model with interaction between age and countries was used for age effect on mortality. Odds-ratios (ORs) were used as measure of association. STATA 15 was used to carry out all analyses.
Findings: Overall case fatality rates were 4.28% for Italy and 2.29% China. The probability of death for an Italian COVID-19 case is nearly twice that for Chinese COVID-19 cases. (OR 1.91; 95%CI 1.69-2.16; P<0.001). The ORs by age classes were lower in Italy than in China. The “age” effect between countries was highly heterogeneous (p-value for heterogeneity <0.001). The association with age is direct and linear, age-specific OR to die tends to 1 in older subgroups. The adjusted OR to die across age was lower in Italy compared to China (OR 0.42; 95% CI 0.26-0.65; p-value <0.001).
Interpretation: Population aging is a significant factor driving high COVID-19 death rates in Italy. Despite a well-structured healthcare system the explosive epidemic has heavily impacted on the elderly. Further studies are required to delineate other factors in geographical differences in death rates.
Funding Statement: The study was funded by Italian Ministry of Health (Independent research funds “Ricerca Corrente INMI Lazzaro Spallanzani IRCCS”).
Declaration of Interests: All authors declare no conflicts of interest.
Keywords: COVID-19, SARS-CoV-2, Outbreak, ageing, Italy
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