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. 2020 May 14:369:m1835.
doi: 10.1136/bmj.m1835.

Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study

Marco Piccininni  1 , Jessica L Rohmann  2 , Luca Foresti  3 , Caterina Lurani  3 , Tobias Kurth  2
Affiliations

Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study

Marco Piccininni et al. BMJ. .

Abstract

Objective: To quantify the impact of coronavirus disease 2019 (covid-19) on all cause mortality in Nembro, an Italian city severely affected by the covid-19 pandemic.

Design: Descriptive study.

Setting: Nembro, in the Bergamo province of Lombardy, northern Italy.

Population: Residents of Nembro.

Main outcome measures: Monthly all cause mortality between January 2012 and April 2020 (data to 11 April), number of confirmed deaths from covid-19 to 11 April 2020, and weekly absolute number of deaths between 1 January and 4 April across recent years by age group and sex.

Results: Nembro had 11 505 residents as of 1 January 2020. Monthly all cause mortality between January 2012 and February 2020 fluctuated around 10 per 1000 person years, with a maximum of 21.5 per 1000 person years. In March 2020, monthly all cause mortality reached a peak of 154.4 per 1000 person years. For the first 11 days in April, this rate decreased to 23.0 per 1000 person years. The observed increase in mortality was driven by the number of deaths among older people (≥65 years), especially men. From the outbreak onset until 11 April 2020, only 85 confirmed deaths from covid-19 in Nembro were recorded, corresponding to about half of the 166 deaths from all causes observed in that period.

Conclusions: The study findings show how covid-19 can have a considerable impact on the health of a small community. Furthermore, the results suggest that the full implications of the covid-19 pandemic can only be completely understood if, in addition to confirmed deaths related to covid-19, consideration is also given to all cause mortality in a given region and time frame.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following competing interests: no support from any organisation for the submitted work; JLR is funded by a grant from the Else-Kröner-Fresenius Foundation (www.ekfs.de, GSO/EKFS-17; TK was the grant recipient). She further reports receiving a research grant from the Soyka Award for Pain Research 2019 sponsored by the German Migraine and Headache Society (DMKG) and Novartis Pharma for work outside this project. LF and CL are employed by Centro Medico Santagostino, a polyclinic that offers private healthcare services in Lombardy. Centro Medico Santagostino is planning to conduct scientific research on the impact of serological testing on covid-19 detection in the coming months, independent of this project. TK reports outside the submitted work to have contributed to an advisory board of CoLucid and a research project funded by Amgen, for which the Charité - Universitätsmedizin Berlin received unrestricted compensation. He further reports having received honorariums from Lilly, Newsenselab, and Total for providing methodological advice, from Novartis and Daiichi Sankyo for providing a lecture on neuroepidemiology and research methods, and from The BMJ for editorial services.

Figures

Fig 1
Fig 1
Population size of Nembro from 1 January 2012 to 11 April 2020. Actual numbers of residents were recorded for the first day of each month between 1 January 2012 and 1 January 2020. Beyond this date (black vertical dashed line), a convex combination of two projections was used to estimate the number of residents to 11 April 2020. The two projections were obtained from the last segment of the spline regression (purple line until 1 January 2020) and a third order polynomial linear regression fitted on the whole observed time period (dotted pink line). The purple line represents the population size used to estimate person years in the main analysis, while the yellow dashed line represents the population size under the possible scenario of large numbers of deaths or emigration after 20 February 2020 (used in the sensitivity analysis)
Fig 2
Fig 2
Monthly all cause mortality per 1000 person years in Nembro between January 2012 and April 2020 (data only available to 11 April). Initials represent the months
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