Gender and age factors affecting the mortality during the COVID-19 epidemic in Italy

BACKGROUND: the COVID-19 epidemic severely affected Italy among European countries causing a considerable number of deaths across the country, especially in Northern Italy, leading also to serious problems to the Italian healthcare system, in particular the overcrowding of Intensive Care Units (ICU). In literature, the debate on the overall mortality during the COVID-19 epidemic, directly and indirectly, associated with the disease, is still open. OBJECTIVES: to describe the time trend of the mortality in Italy during the COVID-19 pandemic accounting for age, gender, and geographical areas. DESIGN: analysis of mortality trend, by region, age, and gender SETTING AND PARTICIPANTS: the Italian mortality data, released by the Italian National Institute of Statistics (Istat), have been considered for the analyses. The data refer to the first four months of 2015-2019 and 2020, involving 7,270 municipalities, corresponding to 93% of the Italian population. MAIN OUTCOME MEASURES: the mortality rates in the first four months of 2015-2019 and 2020, age-adjusted, have been calculated together with the percent variation. The data were analysed by gender, age class (<65; ≥65 years), Region, and geographical areas (Northern versus Central-Southern Italy). The overall daily mortality series have been represented as rates over 100,000 resident population. RESULTS: in addition to the geographical location, the age component was a major determinant of the mortality pattern. The greater increase in the overall mortality was evidenced among elderly subjects in the Northern Italian Regions most affected by the epidemic. In these areas, also gender component played an important role in determining the mortality excess: higher mortality rates in the first four months of 2020 are observed for males in comparison to female populations. CONCLUSIONS: this research reveals that the population components are an important issue in determining the COVID-19 mortality excess. For this reason, it is of primary importance to monitor mortality (overall and by COVID-19) by age and gender and to consider these components and the related factors (comorbidity, exposures affecting the lung) in the public prevention policies towards the protection of the most fragile population groups.