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Observational Study
. 2021 Feb 1;31(1):37-44.
doi: 10.1093/eurpub/ckaa249.

Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

Massimo Fabiani  1 , Alberto Mateo-Urdiales  1   2 , Xanthi Andrianou  1   3 , Antonino Bella  1 , Martina Del Manso  1   2 , Stefania Bellino  1 , Maria C Rota  1 , Stefano Boros  1 , Maria F Vescio  1 , Fortunato P D'Ancona  1 , Andrea Siddu  1 , Ornella Punzo  1 , Antonietta Filia  1 , Silvio Brusaferro  4 , Giovanni Rezza  1 , Maria G Dente  5 , Silvia Declich  5 , Patrizio Pezzotti  1 , Flavia Riccardo  1 ; COVID-19 Working Group
Affiliations
Observational Study

Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system

Massimo Fabiani et al. Eur J Public Health. .

Abstract

Background: International literature suggests that disadvantaged groups are at higher risk of morbidity and mortality from SARS-CoV-2 infection due to poorer living/working conditions and barriers to healthcare access. Yet, to date, there is no evidence of this disproportionate impact on non-national individuals, including economic migrants, short-term travellers and refugees.

Methods: We analyzed data from the Italian surveillance system of all COVID-19 laboratory-confirmed cases tested positive from the beginning of the outbreak (20th of February) to the 19th of July 2020. We used multilevel negative-binomial regression models to compare the case fatality and the rate of admission to hospital and intensive care unit (ICU) between Italian and non-Italian nationals. The analysis was adjusted for differences in demographic characteristics, pre-existing comorbidities, and period of diagnosis.

Results: We analyzed 213 180 COVID-19 cases, including 15 974 (7.5%) non-Italian nationals. We found that, compared to Italian cases, non-Italian cases were diagnosed at a later date and were more likely to be hospitalized {[adjusted rate ratio (ARR)=1.39, 95% confidence interval (CI): 1.33-1.44]} and admitted to ICU (ARR=1.19, 95% CI: 1.07-1.32), with differences being more pronounced in those coming from countries with lower human development index (HDI). We also observed an increased risk of death in non-Italian cases from low-HDI countries (ARR=1.32, 95% CI: 1.01-1.75).

Conclusions: A delayed diagnosis in non-Italian cases could explain their worse outcomes compared to Italian cases. Ensuring early access to diagnosis and treatment to non-Italians could facilitate the control of SARS-CoV-2 transmission and improve health outcomes in all people living in Italy, regardless of nationality.

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Figures

Figure 1
Figure 1
Selection of COVID-19 cases included in the study. ICU, intensive care unit
Figure 2
Figure 2
COVID-19 epidemiological curves in non-Italian nationals (A) and Italian nationals (B), week 8/2020 (17–23 February) to week 29/2020 (13–19 July). HDI, human development index; Pct., percentile
See this image and copyright information in PMC

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