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The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors

The Italian government has been one of the most responsive to COVID-2019 emergency, through the adoption of quick and increasingly stringent measures to contain the outbreak. Despite this, Italy has suffered a huge human and social cost, especially in Lombardy. The aim of this paper is dual: i) firs...

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Autor principal: Perone, Gaetano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier B.V. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833754/
https://www.ncbi.nlm.nih.gov/pubmed/33022464
http://dx.doi.org/10.1016/j.scitotenv.2020.142523
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author Perone, Gaetano
author_facet Perone, Gaetano
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description The Italian government has been one of the most responsive to COVID-2019 emergency, through the adoption of quick and increasingly stringent measures to contain the outbreak. Despite this, Italy has suffered a huge human and social cost, especially in Lombardy. The aim of this paper is dual: i) first, to investigate the reasons of the case fatality rate (CFR) differences across Italian 20 regions and 107 provinces, using a multivariate OLS regression approach; and ii) second, to build a “taxonomy” of provinces with similar mortality risk of COVID-19, by using the Ward's hierarchical agglomerative clustering method. I considered health system metrics, environmental pollution, climatic conditions, demographic variables, and three ad hoc indexes that represent the health system saturation. The results showed that overall health care efficiency, physician density, and average temperature helped to reduce the CFR. By the contrary, population aged 70 and above, car and firm density, air pollutants concentrations (NO(2), O(3), PM(10), and PM(2.5)), relative average humidity, COVID-19 prevalence, and all three indexes of health system saturation were positively associated with the CFR. Population density, social vertical integration, and altitude were not statistically significant. In particular, the risk of dying increases with age, as 90 years old and above had a three-fold greater risk than the 80–to–89 years old and four-fold greater risk than 70–to–79 years old. Moreover, the cluster analysis showed that the highest mortality risk was concentrated in the north of the country, while the lowest risk was associated with southern provinces. Finally, since prevalence and health system saturation indexes played the most important role in explaining the CFR variability, a significant part of the latter may have been caused by the massive stress of the Italian health system.
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spelling pubmed-78337542021-01-26 The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors Perone, Gaetano Sci Total Environ Article The Italian government has been one of the most responsive to COVID-2019 emergency, through the adoption of quick and increasingly stringent measures to contain the outbreak. Despite this, Italy has suffered a huge human and social cost, especially in Lombardy. The aim of this paper is dual: i) first, to investigate the reasons of the case fatality rate (CFR) differences across Italian 20 regions and 107 provinces, using a multivariate OLS regression approach; and ii) second, to build a “taxonomy” of provinces with similar mortality risk of COVID-19, by using the Ward's hierarchical agglomerative clustering method. I considered health system metrics, environmental pollution, climatic conditions, demographic variables, and three ad hoc indexes that represent the health system saturation. The results showed that overall health care efficiency, physician density, and average temperature helped to reduce the CFR. By the contrary, population aged 70 and above, car and firm density, air pollutants concentrations (NO(2), O(3), PM(10), and PM(2.5)), relative average humidity, COVID-19 prevalence, and all three indexes of health system saturation were positively associated with the CFR. Population density, social vertical integration, and altitude were not statistically significant. In particular, the risk of dying increases with age, as 90 years old and above had a three-fold greater risk than the 80–to–89 years old and four-fold greater risk than 70–to–79 years old. Moreover, the cluster analysis showed that the highest mortality risk was concentrated in the north of the country, while the lowest risk was associated with southern provinces. Finally, since prevalence and health system saturation indexes played the most important role in explaining the CFR variability, a significant part of the latter may have been caused by the massive stress of the Italian health system. Elsevier B.V. 2021-02-10 2020-09-24 /pmc/articles/PMC7833754/ /pubmed/33022464 http://dx.doi.org/10.1016/j.scitotenv.2020.142523 Text en © 2020 Elsevier B.V. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Perone, Gaetano
The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title_full The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title_fullStr The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title_full_unstemmed The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title_short The determinants of COVID-19 case fatality rate (CFR) in the Italian regions and provinces: An analysis of environmental, demographic, and healthcare factors
title_sort determinants of covid-19 case fatality rate (cfr) in the italian regions and provinces: an analysis of environmental, demographic, and healthcare factors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833754/
https://www.ncbi.nlm.nih.gov/pubmed/33022464
http://dx.doi.org/10.1016/j.scitotenv.2020.142523
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