178 thousand excess mortality cases since the beginning of the pandemic

ISS, 02 March 2022

Seventh ISTAT-ISS Report, in 2021 especially in the first four months

From the beginning of the pandemic (March 2020) to January 2022, total excess mortality, compared to the 2015-2019 average, was 178,000 deaths, with much of the 2021 excess mortality being observed in the first four months when vaccination coverage was still very low. These data are reported in the seventh joint report by the National Statistics Institute (ISTAT) and the Istituto Superiore di Sanità – ISS (National Institute of Health) on the impact of the epidemic on total mortality published today. The report contains several additional chapters compared to previous editions, including an analysis of a sample of 6,530 death records related to individuals who died in 2021 and reported to the COVID-19 Integrated Surveillance System and a comparison with the trend of excess mortality in the EU.

What is excess mortality associated with the COVID-19 pandemic

Difference between overall deaths from all causes since the beginning of the pandemic and the expected trend of deaths based on the expected historical trend (average of the 2015-2019 period) if the COVID-19 pandemic had not occurred. With this indicator both the direct and indirect impact of the pandemic can be measured thus providing a more objective measure of the deaths directly associated with COVID-19

SUMMARY OF THE MAIN RESULTS

• Since the beginning of the epidemic, 10,953,342 confirmed cases of COVID-19 have been reported to the Integrated Surveillance System (data extracted on 9/2/2022); of these, over 4.5 million cases were diagnosed in January 2022 (42% of the total cases reported to the Surveillance System since the beginning of the pandemic) due to the predominance of the Omicron variant characterized by very high transmissibility.
• 145,334 deaths associated with a diagnosis of SARS-CoV-2 infection that occurred by 31 January 2022 were reported to the COVID-19 Integrated National Surveillance System of the ISS. 53% of deaths occurred in 2020, 41% in 2021 (59,136 deaths, of which about 8,000 being diagnoses made in 2020) and 5.8% in January 2022.
• The vaccination campaign, which began on 27 December 2020, reached high levels of coverage starting from May 2021, especially for the more advanced age groups (60+).
• As the vaccination campaign progressed, mortality decreased significantly starting from the 20th week of 2021: approximately 82% of deaths in 2021 occurred in the first four months of the year. In particular, there was a major reduction in COVID-19 mortality in the age group of 80 year olds and over, for whom vaccination coverage with the first vaccine injection was approximately 95% by the end of 2021.
• Analysing the ratios between the standardized COVID-19 mortality rates in 2021 and those of 2020, it is observed that the North-South gradient was reversed to the detriment of the Center-South of the Country; this reversal in the gradient is reflected in the mortality rates for all causes.
• From the beginning of the pandemic (March 2020) to the end of January 2022, the total excess mortality, compared to the 2015-2019 average, was 178,000 deaths. In 2020, the total number of deaths due to all causes was the highest ever recorded in our Country since the Second World War: 746,146 deaths^[1], 100,526 deaths more than the 2015-2019 average (15.6% excess). In 2021 the total number of deaths due to all causes declined compared to the previous year, even if it remained at very high levels: 709,035 deaths, 37,000 less than in 2020 (-5.0%), but 63,000 more than the 2015-2019 average (+ 9.8%). Much of the excess mortality of 2021 was observed in the first four months when the vaccination coverage was still very low.
• Compared to 2020, in 2021 there was an increase in excess mortality in the regions of the Centre (+ 1.0%) and the South (+ 4.8%). The decline in the overall number of deaths in 2021 compared to 2020 was mainly due to the decrease in deaths in the North (-13.2%), which had been the most heavily affected area of the Country in the first wave of the pandemic in 2020.
• Considering the age groups, the most significant contribution to excess mortality in 2021, compared to the average for the 2015-2019 period, was the increase in deaths of the people aged 80 and over which explains the overall 72% of excess mortality; a total of 455,170 people aged 80 and over died (about 46,000 more than the average for the 2015-2019 five-year period). The increase in mortality in the 65-79 age group accounts for a further 21% of excess deaths; in absolute terms, the increase in deaths for this age group, compared to the average for the 2015-2019 period, is over 13,000 deaths (for a total of 177,937 deaths in 2021).
• Although it is confirmed that even in 2021 people aged 65 and over were the most affected in terms of excess mortality, in 2021 there was a large decline in deaths in this age group: 37,000 less than in 2020.
• The comparison between the epidemic waves of COVID-19 in terms of excess mortality shows that in the current wave the impact on mortality is lower than in previous waves. Despite the spread of new, more transmissible variants, during the 1 October 2021 - 31 January 2022 period there were about 250,000 deaths, 40,000 fewer than in the previous 12 months, with a decrease of more than 13%.
• In a sample of 6,530 death records related to individuals who died in 2021 and reported to the COVID-19 Integrated Surveillance System, the presence of COVID-19 was assessed to be the initial cause, its complications and the presence of other contributing causes. In 90% of the reports, COVID-19 was indicated as being the direct cause of death, similar to what had already been observed in 2020 (89%). Conditions typically associated with COVID-19, such as pneumonia, respiratory failure, acute respiratory distress (ARDS) or other respiratory symptoms, were present as complications in 90% of the records. COVID-19 was the only cause for death in 23% of cases, while in 29% of cases there was one contributing cause besides COVID-19, and in 48% there were several causes.
• As regards the European context, in 2021 the trend in excess mortality in the EU reached a peak in April (21.0%), then dropped to 10.6% in May and reached a low of 5, 6% in July. A new rise was observed in the Autumn when the excess mortality reached 17.7% in October and 26.5% in November 2021 (Eurostat data). Compared to the European average, Italy recorded excess mortality peaks in November 2020 and in March 2021. Starting from July 2021, excess mortality in our Country has fallen well below the EU average.