Deaths in SARS-Cov-2 Positive Patients in Italy: The Influence of Underlying Health Conditions on Lethality

Abstract

This study aims to underline the clinical characteristics of patients who died after testing positive for SARS-CoV-2 infection in one region of Italian and to evaluate the influence of underlying health conditions on the fatal outcome. A matched case-control study was designed by analyzing the data regarding positive subjects observed up to April 21, 2020. The case fatality rate was 7.9%, with a higher proportion of deaths in men than women. The specific standardized mortality ratio was 0.15-0.13 for males and 0.2 for females, showing that mortality is much lower than expected. Cardiovascular diseases, chronic lung diseases and diabetes mellitus showed a significant association with the outcome. Although the case fatality rate in Sardinia in regard to age and gender patterns seems to be similar to that for Italy as a whole, its quantitative value was far lower than the national one and possible explanations might include the genetic characteristics of the Sardinian population or the immediate closure of its borders as soon as the epidemic started. Our results highlighted that lethality is strongly dependent on the presence of multiple concomitant serious diseases. It is important to have epidemiological strategies for effective guidance on public health actions in order to improve chances of survival.

Keywords: COVID-19; Italy; SARS-CoV-2; lethality; underlying health conditions.

Figure 1

Underlying health conditions of the 90 deceased patients with SARS-CoV-2 in Sardinia.

Figure 2

Trajectories of specific SARS-CoV-2 case fatality rate for Sardinian and Italian population by age groups and gender. (a) Sardinia—males. (b) Sardinia—females. (c) Italy—males. (d) Italy—females.

Figure 3

Case control study: underlying health conditions in both male (a) and female (b) cases deceased with SASRS-Cov-2 and paired controls. * p-value < 0.05.