COVID-19 mortality rate in nine high-income metropolitan regions

Main Article Content

Carlo Signorelli
Anna Odone
Vincenza Gianfredi
Eleonora Bossi
Daria Bucci
Aurea Oradini-Alacreu
Beatrice Frascella
Michele Capraro
Federica Chiappa
Lorenzo Blandi
Fabio Ciceri

Keywords

COVID-19, Mortality, Metropolitan regions, Hospital care system

Abstract

We analyzed the spread of the COVID-19 epidemic in 9 metropolitan regions of the world with similar socio-demographic characteristics, daytime commuting population and business activities: the New York State, Bruxelles-Capital, the Community of Madrid, Catalonia, the Île-de-France Region, the Greater London county, Stockholms län, Hovedstaden (Copenhagen) and the Lombardy Region. The Lombardy region reported the highest COVID-19 crude mortality rate (141.0 x 100,000) 70-days after the onset of the epidemic, followed by the Community of Madrid (132.8 x 100,000) New York State (120.7 x 100,000). The large variation in COVID-19 mortality and case-fatality rates for COVID-19 in different age strata suggested a more accurate analysis and interpretation of the epidemic dynamics after standardization of the rates by age. The share of elder populations (>70 years) over total population varies widely in the considered study settings, ranging from 6.9% in Catalonia to 17.0% in Lombardy. When taking age distribution into consideration the highest standardized mortality rate was observed in the State of New York (257.9 x 100,000); with figures in most of the European regions concentrated between 123.3 x 100,000 in Greater London and 177.7 x 100,000 in Bruxelles-Capital, lower in French and Danish regions. We also report and critical appraise, when available, COVID-19 mortality figures in capital cities, nursing homes, as well as excess mortality at country level. Our data raise awareness on the need for a more in-depth epidemiological analysis of the current COVID-19 public health emergency that further explores COVID-19 mortality determinants associated with health services delivery, community-level healthcare, testing approaches and characteristics of surveillance systems, including classification of COVID-19 deaths.

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References

1. Wilder-Smith A, Chiew CJ, Lee VJ. Can we contain the COVID-19 outbreak with the same measures as for SARS? Lancet Infect Dis. 2020.
2. Kraemer MUG, Yang CH, Gutierrez B, Wu CH, Klein B, Pigott DM, et al. The effect of human mobility and control measures on the COVID-19 epidemic in China. Science. 2020;in press.
3. Amerio A, Bianchi D, Santi F, Costantini L, Odone A, Signorelli C, et al. Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners. Acta Biomed. 2020;91(2):83-8.
4. Signorelli C, Scognamiglio T, Odone A. COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Acta Biomed. 2020;91(3-S):175-9.
5. Tang B, Wang X, Li Q, Bragazzi NL, Tang S, Xiao Y, et al. Estimation of the Transmission Risk of the 2019-nCoV and Its Implication for Public Health Interventions. J Clin Med. 2020;9(2).
6. Mayor S. Covid-19: Researchers launch app to track spread of symptoms in the UK. BMJ. 2020;368:m1263.
7. Gianfredi V, Odone A, Fiacchini D, Rosselli R, Battista T, Signorelli C. Trust and reputation management, branding, social media management nelle organizzazioni sanitarie: sfide e opportunità per la comunità igienistica italiana. J Prev Med Hyg. 2019;60(3):E108-E9.
8. Gianfredi V, Grisci C, Nucci D, Parisi V, Moretti M. [Communication in health.]. Recenti Prog Med. 2018;109(7):374-83.
9. Moro M, Vigezzi GP, Capraro M, Biancardi A, Nizzero P, Signorelli C, et al. 2019-novel coronavirus survey: knowledge and attitudes of hospital staff of a large Italian teaching hospital. Acta Biomed. 2020;91(3-s):29-34.
10. Signorelli C, Fara GM. COVID-19: Hygiene and Public Health to the front. Acta Biomed. 2020;91(3-S):7-8.
11. Capolongo S, Rebecchi A, Buffoli M, Appolloni L, Signorelli C, Fara GM, et al. COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities. Acta Biomed. 2020;91(2):13-22.
12. Signorelli C, Odone A, Gianfredi V, Bossi E, Bucci D, Oradini-Alacreu A, et al. The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan. Acta Biomed. 2020;91(2):23-30.
13. Russo P. Coronavirus, le stime dei ricercatori: “In Italia almeno 2800 morti non dichiarati” 2020 [Access date 13 April 2020. Available from: https://www.lastampa.it/topnews/primo-piano/2020/03/30/news/le-stime-dei-ricercatori-almeno-2800-morti-non-dichiarati-1.38653880.
14. United States Census. Explore Census Data 2020 [Access date 13 April 2020. Available from: https://data.census.gov/cedsci/.
15. Department of Health- New York State. Nursing Home and ACF COVID Related Deaths Statewide 2020 [Access date 17 June 2020. Available from: https://www.health.ny.gov/statistics/diseases/covid-19/fatalities_nursing_home_acf.pdf.
16. Centers for Disease Control and Prevention. Excess Deaths Associated with COVID-19 2020 [Access date 17 June 2020. Available from: https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm.
17. Centers for Disease Control and Prevention. CDC COVID Data Tracker 2020 [Access date 17 June 2020. Available from: https://www.cdc.gov/covid-data-tracker/#cases.
18. NYC Health. COVID-19: Data 2020 [Access date 17 June 2020. Available from: https://www1.nyc.gov/site/doh/covid/covid-19-data.page.
19. European Commission. Population: Demographic situation, languages and religions 2019 [Access date 13 April 2020. Available from: https://eacea.ec.europa.eu/national-policies/eurydice/content/population-demographic-situation-languages-and-religions-7_en.
20. City population. Bruxelles Municipality 2019 [Access date 13 April 2020. Available from: https://www.citypopulation.de/en/belgium/bruxelles/_/21004__bruxelles/.
21. The Brussels Times. Nursing home residents make up nearly half of Belgium’s coronavirus deaths 2020 [Access date 13 April 2020. Available from: https://www.brusselstimes.com/all-news/belgium-all-news/105848/nearly-half-of-belgiums-coronavirus-deaths-are-nursing-home-residents/.
22. Statista. Observed and expected weekly death tolls in the Brussels-Capital Region (Belgium) from February to April 2020 2020 [Access date 15 June 2020. Available from: https://www.statista.com/statistics/1114383/excess-deaths-in-brussels-by-coronavirus/.
23. Sciensano. COVID-19 - Situation épidémiologique 2020 [Access date 15 April 2020. Available from: https://epistat.wiv-isp.be/covid/.
24. Portal del Ayuntamiento de Madrid. Portal web del Ayuntamiento de Madrid 2019 [Access date 13 April 2020. Available from: https://www.madrid.es/portal/site/munimadrid#.
25. Instituto Nacional de Estadistica. Demografía y población 2019 [Access date 13 April 2020. Available from: https://www.ine.es/.
26. Ministerio de Sanidad de España. Radiografía del coronavirus en residencias de ancianos: más de 19.500 muertos con Covid-19 o síntomas compatibles 2020 [Access date 17 June 2020. Available from: https://www.rtve.es/noticias/20200614/radiografia-del-coronavirus-residencias-ancianos-espana/2011609.shtml.
27. EuroMOMO. EuroMOMO Bulletin, Week 23, 2020 2020 [Access date 17 June 2020. Available from: https://www.euromomo.eu/.
28. Istituto Nacional de Estadistica. Estimación del número de defunciones semanales durante el brote de covid-19 2020 [Access date 17 June 2020. Available from: https://www.ine.es/experimental/defunciones/experimental_defunciones.htm#tablas_resultados.
29. Ministerio de Sanidad de España. Situación de COVID-19 en España 2020 [Access date 13 June 2020. Available from: https://covid19.isciii.es/.
30. Institut National de la statistique et des études éeconomiques. The National Institute of Statistics and Economic Studies collects, analyses and disseminates information on the French economy and society 2019 [Access date 13 April 2020. Available from: https://www.insee.fr/en/accueil.
31. Institut National de la statistique et des études éeconomiques. The National Institute of Statistics and Economic Studies collects, analyses and disseminates information on the French economy and society 2019 [Access date 17 June 2020. Available from: https://www.insee.fr/en/accueil.
32. Caisse nationale de solidarieté pour l'autonomie. Annuaire des EHPAD et maisons de retraite 2020 [Access date 18 June 2020. Available from: https://www.pour-les-personnes-agees.gouv.fr/annuaire-ehpad-et-maisons-de-retraite?departement=PARIS%20(75)#container-result-query.
33. Santè Publique France. COVID-19 : point épidémiologique en Ile-de-France du 11 juin 2020 2020 [Access date 18 June 2020. Available from: https://www.santepubliquefrance.fr/regions/ile-de-france/documents/bulletin-regional/2020/covid-19-point-epidemiologique-en-ile-de-france-du-11-juin-2020.
34. Istitut National de la statistique et des ètudes èconomiques. Info coronavirus 2020 [Access date 18 June 2020. Available from: https://www.insee.fr/fr/statistiques/4487861?sommaire=4487854
35. Gouvernement France. COVID-19 en France 2020 [Access date 13 April 2020. Available from: https://www.gouvernement.fr/info-coronavirus/carte-et-donnees.
36. World Population Review. London Population 2020 2020 [Access date 15 April 2020. Available from: https://worldpopulationreview.com/world-cities/london-population/.
37. United States Census. New York County (Manhattan Borough), New York 2020 [Access date 18 June 2020. Available from: https://www.census.gov/quickfacts/newyorkcountymanhattanboroughnewyork.
38. Office for National Statistics. Number of deaths in care homes notified to the Care Quality Commission, England. 2020 [Access date 18 June 2020. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/numberofdeathsincarehomesnotifiedtothecarequalitycommissionengland.
39. Office for National Statistics. Deaths registered weekly in England and Wales, provisional: week ending 22 May 2020. 2020 [Access date 18 June 2020. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest.]
40. NHS England. COVID-19 Daily Deaths 2020 [Access date 15 April 2020. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/.]
41. World Population Review. Stockholm Population 2019 2020 [Access date 15 June 2020. Available from: https://worldpopulationreview.com/world-cities/stockholm-population/.]
42. European Centre for Disease Prevention and Control. Surveillance of COVID-19 at longterm care facilities in the EU/EEA. Stockholm; 2020.
43. Socialstyrelsen. Statistik relaterad till covid-19 2020 [Access date 15 June 2020. Available from: https://www.socialstyrelsen.se/statistik-och-data/statistik/statistik-om-covid-19/statistik-relaterad-till-covid-19/.]
44. Statistics Denmark. Population 2019 2020 [Access date 15 June 2020. Available from: https://www.dst.dk/en/Statistik/emner/befolkning-og-valg.]
45. Dun and Bradstreet Coronavirus Resources. Nursing Homes & Long-Term Care Facilities Companies In Hovedstaden, Denmark 2020 [Access date 17 June 2020. Available from: https://www.dnb.com/business-directory/company-information.nursing-homes-long-term-care-facilities.dk.hovedstaden.html?page=5.]
46. Istituto Nazionale di Statistica (ISTAT). Popolazione residente al 1° gennaio 2019 [Access date 13 April 2020. Available from: http://dati.istat.it/Index.aspx?DataSetCode=DCIS_POPRES1.]
47. Regione Lombardia-ATS Milano Città Metropolitana. RSA Flusso Covid 19. 2020. [Access date 17 June 2020. Available from: https://www.ats-milano.it/portale/Portals/0/emergenza%20coronavirus/Report%2013_05_20_Flusso%20Covid%20RSA.pdf]
48. Istituto Nazionale di Statistica (ISTAT). Decessi e cause di morte: cosa produce l’ISTAT 2020 [Access date 18 June 2020. Available from: https://www.istat.it/it/archivio/240401.]
49. Dipartimento della Protezione Civile. COVID-19 Italia-Monitoraggio della situazione 2020 [Access date 18 June 2020. Available from: http://www.protezionecivile.gov.it/attivita-rischi/rischio-sanitario/emergenze/coronavirus.
50. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England journal of medicine. 2020;382(8):727-33.
51. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020.
52. European Centre for Disease Prevention and Control. Rapid Risk Assessment: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK- ninth update. Stockholm2020.
53. Ministero della Salute. Covid-19 - Situazione in Italia 2020 [Access date 13 April 2020. Available from: http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?area=nuovoCoronavirus&id=5351&lingua=italiano&menu=vuoto.]
54. Associazione gestione servizi socio-sanitari e cure post intensive. Documento di chiarificazione presentato da AGeSPI Lombardia alla Commissione RSA Lombardia. Milano: AGeSI Lombardia; 2020.
55. Scott A. Is a reagents shortage delaying European COVID-19 testing? Chemical and Engineering news. 2020;98(13).
56. Sechi GM, Migliori M, Dassi G, Pagliosa A, Bonora R, Oradini-Alacreu A, et al. Business Intelligence applied to Emergency Medical Services in the Lombardy region during SARS-CoV-2 epidemic. Acta Biomed. 2020;91(2):39-44.
57. Lazzerini M, Putoto G. COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health. 2020.
58. Romanò L, Pariani E, Biganzoli E, Castaldi S. The end of lockdown what next ? Acta Biomedica. 2020;91(2).
59. Odone A, Delmonte D, Scognamiglio T, Signorelli C. COVID-19 deaths in Lombardy, Italy: data in context. The Lancet Public health. 2020;5(6):e310.
60. Tátrai D, Várallyay Z. COVID-19 epidemic outcome predictions based on logistic fitting and estimation of its reliability. arXiv preprint. 2020.
61. Pecoraro F, Luzi D, Clemente F. Analysis of the different approaches adopted in the Italian regions to care for patients affected by COVID-19. Heliyon. 2020;in press.
62. Banerjee A, Pasea L, Harris S, Gonzalez-Izquierdo A, Torralbo A, Shallcross L, et al. Estimating excess 1-year mortality associated with the COVID-19 pandemic according to underlying conditions and age: a population-based cohort study. Lancet (London, England). 2020;395(10238):1715-25.
63. Gianfredi V, Balzarini F, Gola M, Mangano S, Carpagnano LF, Colucci ME, et al. Leadership in Public Health: Opportunities for Young Generations Within Scientific Associations and the Experience of the "Academy of Young Leaders". Front Public Health. 2019;7:378.
64. Sciensano. COVID19 BE open data codebook. 2020. [Access date 13 June 2020. Available from: https://epistat.sciensano.be/COVID19BE_codebook.pdf]
65. Gouvernement France. COVID-19 2020 [Access date 13 June 2020. Available from: https://www.gouvernement.fr/info-coronavirus/carte-et-donnees.]
66. NHS england. COVID-19 Daily Deaths 2020 [Access date 13 June 2020. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/.]
67. Folkhalsomyndig. Totalt antal laboratoriebekräftade 2020 [Access date 13 June 2020. Available from: https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa.]
68. Statens Serum Institut. COVID-19 i Danmark. 2020. [Access date 13 June 2020. Available from: https://www.ssi.dk/aktuelt/sygdomsudbrud/coronavirus/covid-19-i-danmark-epidemiologisk-overvaagningsrapport]
69. Istituto Superiore di Sanità. Characteristics of SARS-CoV-2 patients dying in Italy Report based on available data on April 20th, 2020 [Access date 13 June 2020. Available from: https://www.epicentro.iss.it/en/coronavirus/bollettino/Report-COVID-2019_20_april_2020.pdf.]