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Title: Epidemiological characteristics of COVID-19 cases in non-Italian nationals notified to the Italian surveillance system
Authors: Fabiani, Massimo 
Mateo-Urdiales, Alberto 
Andrianou, Xanthi 
Bella, Antonino 
Del Manso, Martina 
Bellino, Stefania 
Rota, Maria C 
Boros, Stefano 
Vescio, Maria F 
D'Ancona, Fortunato P 
Siddu, Andrea 
Punzo, Ornella 
Filia, Antonietta 
Brusaferro, Silvio 
Rezza, Giovanni 
Dente, Maria G 
Declich, Silvia 
Pezzotti, Patrizio 
Riccardo, Flavia 
Major Field of Science: Medical and Health Sciences
Field Category: Health Sciences
Keywords: Comorbidity;Demography;Disease outbreaks;Intensive care unit;Italy;Refugees;Infections;Diagnosis;Economics;Morbidity;Mortality;Traveler;Surveillance;Case fatality rate;Health outcomes;Hospital admission;Delayed diagnosis;Human development index;Sars-cov-2;Covid-19
Issue Date: 1-Feb-2021
Source: European Journal of Public Health, 2021, vol. 31, no. 1, pp. 37 - 44
Volume: 31
Issue: 1
Start page: 37
End page: 44
Journal: European Journal of 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.
ISSN: 1464-360X
DOI: 10.1093/eurpub/ckaa249
Rights: © The Author(s).
Type: Article
Affiliation : Istituto Superiore di Sanità 
European Centre for Disease Prevention and Control 
Cyprus University of Technology 
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