Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 27;9(11):3459.
doi: 10.3390/jcm9113459.

The Role of COVID-19 in the Death of SARS-CoV-2-Positive Patients: A Study Based on Death Certificates

Francesco Grippo  1 , Simone Navarra  1 , Chiara Orsi  1 , Valerio Manno  2 , Enrico Grande  1 , Roberta Crialesi  1 , Luisa Frova  1 , Stefano Marchetti  1 , Marilena Pappagallo  1 , Silvia Simeoni  1 , Lucilla Di Pasquale  2 , Annamaria Carinci  2 , Chiara Donfrancesco  3 , Cinzia Lo Noce  3 , Luigi Palmieri  3 , Graziano Onder  3 , Giada Minelli  2 ; Italian National Institute of Health Covid-Mortality Group
Collaborators, Affiliations

The Role of COVID-19 in the Death of SARS-CoV-2-Positive Patients: A Study Based on Death Certificates

Francesco Grippo et al. J Clin Med. .

Abstract

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30-59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.

Keywords: COVID-19; comorbidities; death certificates.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Age and gender distribution of all deaths occurring in SARS-CoV-2–positive patients on 28 May 2020 (n = 31,851) and in the study sample (n = 5311).
Figure 1
Figure 1
Distribution of the main comorbidities on death certificates, by age group.
Figure 2
Figure 2
Main fatal complications of COVID-19 by gender and age group. Percentage of mention of the condition as complication of COVID-19 on total deaths.
See this image and copyright information in PMC

References

    1. Riccardo F., Ajelli M., Andrianou X.D., Bella A., Del Manso M., Fabiani M., Bellino S., Boros S., Urdiales A.M., Marziano V., et al. Epidemiological characteristics of COVID-19 cases in Italy and estimates of the reproductive numbers one month into the epidemic. medRxiv. 2020 doi: 10.1101/2020.04.08.20056861. preprint. - DOI - PMC - PubMed
    1. Onder G., Rezza G., Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020;323:1775–1776. doi: 10.1001/jama.2020.4683. - DOI - PubMed
    1. Zheng Z., Peng F., Xu B., Zhao J., Liu H., Peng J., Li Q., Jiang C., Zhou Y., Liu S., et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J. Infect. 2020;81:e16–e25. doi: 10.1016/j.jinf.2020.04.021. - DOI - PMC - PubMed
    1. Palmieri L., Vanacore N., Donfrancesco C., Lo Noce C., Canevelli M., Punzo O., Raparelli V., Pezzotti P., Riccardo F., Bella A., et al. Clinical characteristics of hospitalized individuals dying with COVID-19 by age group in Italy. J. Gerontol. A Biol. Sci. Med. Sci. 2020;75:1796–1800. doi: 10.1093/gerona/glaa146. - DOI - PMC - PubMed
    1. ONS Measuring Pre-Existing Health Conditions in Death Certification—Deaths Involving COVID-19: March 2020. [(accessed on 27 August 2020)]; Available online: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri....

LinkOut - more resources