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
. 2022 Oct:211:136-143.
doi: 10.1016/j.puhe.2022.07.022. Epub 2022 Aug 11.

Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data

M Fabiani  1 , M F Vescio  2 , M Bressi  2 , A Mateo-Urdiales  2 , D Petrone  2 , M Spuri  2 , C Sacco  2 , M Del Manso  2 , A Bella  2 , F D'Ancona  2 , M C Rota  2 , A Filia  2 , S Declich  2 , G Marchetti  2 , A Petrelli  3 , A Di Napoli  3 , F Riccardo  2 , A T Palamara  2 , P Pezzotti  2 ; Italian Integrated Surveillance of COVID-19 Study Group
Affiliations

Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data

M Fabiani et al. Public Health. 2022 Oct.

Abstract

Objectives: This study was to compare the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals.

Study design: We retrospectively analysed data from the COVID-19 Italian integrated surveillance system (14 September 2020 to 17 October 2021).

Methods: We used multivariable Cox proportional hazards models to estimate the hazard ratio (HR) of infection and, among cases, the HRs of death, hospitalisation and subsequent admission to intensive care unit in non-Italian nationals relative to Italian nationals. Estimates were adjusted for differences in sociodemographic characteristics and in the week and region of diagnosis.

Results: Of 4,111,067 notified cases, 336,265 (8.2%) were non-Italian nationals. Compared with Italian nationals, non-Italians showed a lower incidence of SARS-CoV-2 infection (HR = 0.81, 95% confidence interval [CI]: 0.80-0.81). However, once diagnosed, they were more likely to be hospitalised (HR = 1.90, 95% CI: 1.87-1.92) and then admitted to intensive care unit (HR = 1.08, 95% CI: 1.04-1.13), with differences larger in those coming from countries with a lower human development index. Compared with Italian cases, an increased rate of death was observed in non-Italian cases from low-human development index countries (HR = 1.41, 95% CI: 1.23-1.62). The HRs of SARS-CoV-2 infection and severe outcomes slightly increased after the start of the vaccination campaign.

Conclusions: Underdiagnosis and delayed diagnosis in non-Italian nationals could explain their lower incidence compared with Italians and, among cases, their higher probability to present clinical conditions leading to worse outcomes. Facilitating early access to vaccination, diagnosis and treatment would improve the control of SARS-CoV-2 transmission and health outcomes in this vulnerable group.

Keywords: Case hospitalisation rate; Immigrants; Incidence; Italy; Lethality; SARS-CoV-2 infection.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Selection of the population included in the study. ICU, intensive care unit.
Fig. 2
Fig. 2
SARS-CoV-2 infection epidemiological curves in non-Italian nationals (A) and Italian nationals (B), week 38/2020 (14–20 September) to week 41/2021 (11–17 October). HDI, human development index.
Fig. 3
Fig. 3
Hazard ratio of SARS-CoV-2 infection and subsequent death, hospitalisation, and admission to ICU by nationality and epidemic phase. HR, hazard ratio adjusted for sex, age, geographical region of diagnosis, level of urbanisation of the municipality of residence, level of social and material vulnerability of the municipality of residence and calendar week of diagnosis; CI, confidence interval; HDI, human development index; ICU, intensive care unit.
See this image and copyright information in PMC

References

    1. Sze S., Pan D., Nevill C.R., Gray L.J., Martin C.A., Nazareth J., et al. Ethnicity and clinical outcomes in COVID-19: a systematic review and meta-analysis. EClinicalMedicine. 2020;29 - PMC - PubMed
    1. Mathur R., Rentsch C.T., Morton C.E., Hulme W.J., Schultz A., MacKenna B., et al. Ethnic differences in SARS-CoV-2 infection and COVID-19 related hospitalisation, intensive care unit admission, and death in 17 million adults in England: an observational cohort study using the OpenSAFELY platform. Lancet. 2021;397:1711–1724. - PMC - PubMed
    1. Hayward S.E., Deal A., Cheng C., Crawshaw A., Orcutt M., Vandrevala T.F., et al. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: a systematic review. J Migr Health. 2021;3 - PMC - PubMed
    1. Jaljaa A., Carminada S., Tosti M.E., D’Angelo F., Angelozzi A., Isonne C., et al. Risk of SARS-CoV-2 infection in migrants and ethnic minorities compared with the general population in the European WHO region during the first year of the pandemic: a systematic review. BMC Public Health. 2022;22:143. - PMC - PubMed
    1. Hargreaves S., Hayward S.E., Noori T., McKee M., Kumar B. COVID-19: counting migrants in. Lancet. 2021;398:211–212. - PMC - PubMed