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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 2020

See all articles by Simone Lanini

Simone Lanini

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Francesco Vairo

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Vincenzo Puro

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Paola Scognamiglio

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Franco Locatelli

Bambino Gesù Children's Hospital - Oncohaematology Department

Chao Zhang

Government of the People's Republic of China - Treatment and Research Center for Infectious Diseases

Fu-Sheng Wang

Government of the People's Republic of China - Treatment and Research Center for Infectious Diseases

Alimuddin Zumla

University College London - Division of Infection and Immunity

Giuseppe Ippolito

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

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Abstract

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

Suggested Citation

Lanini, Simone and Vairo, Francesco and Puro, Vincenzo and Scognamiglio, Paola and Locatelli, Franco and Zhang, Chao and Wang, Fu-Sheng and Zumla, Alimuddin and Ippolito, Giuseppe, Higher Death Rates in the Italian COVID-19 Outbreak: A Comparative Modelling Analysis of 8,342 Italy and 44,672 China Cases (3/15/2020). Available at SSRN: https://ssrn.com/abstract=3556640 or http://dx.doi.org/10.2139/ssrn.3556640

Simone Lanini

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI ( email )

Rome
Italy

Francesco Vairo

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI ( email )

Rome
Italy

Vincenzo Puro

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Rome
Italy

Paola Scognamiglio

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Rome
Italy

Franco Locatelli

Bambino Gesù Children's Hospital - Oncohaematology Department ( email )

Italy

Chao Zhang

Government of the People's Republic of China - Treatment and Research Center for Infectious Diseases ( email )

China

Fu-Sheng Wang

Government of the People's Republic of China - Treatment and Research Center for Infectious Diseases ( email )

China

Alimuddin Zumla

University College London - Division of Infection and Immunity ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Giuseppe Ippolito (Contact Author)

Institute of Hospitalization and Care with a Scientific Character (IRCCS) - Lazzaro Spallanzani National Institute for Infectious Diseases - INMI

Rome
Italy

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