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.

Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system / Fabiani, M.; Mateo-Urdiales, A.; Andrianou, X.; Bella, A.; Del Manso, M.; Bellino, S.; Rota, M. C.; Boros, S.; Vescio, M. F.; D'Ancona, F. P.; Siddu, A.; Punzo, O.; Filia, A.; Brusaferro, S.; Rezza, G.; Dente, M. G.; Declich, S.; Pezzotti, P.; Riccardo, F.; Castrucci, M. R.; Ciervo, A.; Di Benedetto, C.; Giannitelli, S.; Stefanelli, P.; Tallon, M.; Urciuoli, R.; Di Giacomo, M.; La Bianca, M.; Mignuoli, A. D.; D'Argenzio, A.; Massimiliani, E.; Gallo, T.; Scognamiglio, P.; Sticchi, C.; Cereda, D.; Fiacchini, D.; Sforza, F.; G. Zuccaro, M.; P. Benetollo, P.; Tiberti, D.; Chironna, M.; A. Palmas, M.; Scondotto, S.; Pecori, L.; Tosti, A.; Ruffier, M.; Da Re, F.. - In: EUROPEAN JOURNAL OF PUBLIC HEALTH. - ISSN 1101-1262. - 31:1(2021), pp. 37-44. [10.1093/eurpub/ckaa249]

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

Rezza G.;
2021-01-01

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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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/157838
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