Excess mortality in Mountain Areas of Emilia Romagna Region during the first months of SARS-CoV-2 pandemic: a “canary in the coal mine”?

BACKGROUND. Because of their remoteness, Mountain Communities (MC) have been considered at advantage when dealing with infectious diseases. However, earlier reports have identified MC among the hotspots for early spreading of COVID-19 pandemic. METHODS. Crude mortality rates (CMR) and Excess mortality rates (EMR) were calculated for 97 municipalities from MC in the Emilia Romagna Region (North-Eastern Italy), and resulting estimates were compared to the Parent Provinces. Notification and mortality rates for COVID-19 were also retrieved, and correlated with EMR estimates. RESULTS. During 2020, a CMR of 150.3/100,000 (95% Confidence Interval [95%CI] 117-185.4) was identified, with substantial heterogeneities between the 8 provinces of Emilia Romagna Region that were included in the analyses. A pooled EMR of +20.3% (95%CI 10.6-30.1) for MC and 19.9% (95%CI 9.5-30.3) was identified. The monthly estimates were quite heterogenous across the various provinces, ranging between -79.7% and +307.4% during the assessed timeframe. Higher estimates were identified in the months of March and April in MC, and during the months of April and May for Parent Provinces. In bivariate analysis, EM in MC was loosely but positively correlated with estimates in the parent province (Spearman’s r = 0.201, p = 0.049), and also with notification rates for COVID- (i.e. Piacenza, Parma, Reggio Emilia, Modena, Bologna, Ravenna, Rimini, and Forlì Cesena) (r = 0.225, p = 0.045), and particularly with mortality rates for COVID-19 at provincial level (r = 0.372, p < 0.001). CONCLUSIONS. In summary, the study highlights that small geographical and population size, along with remoteness, did not play a substantial advantage for MC against the spread and mortality rate of COVID-19. On the other hand, as the surge of EM in MC anticipated a similar habit in Parent Provinces of several weeks, improved surveillance interventions are also urgently in need. (www.actabiomedica.it)