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Article

The Role of COVID-19 in the Death of SARS-CoV-2–Positive Patients: A Study Based on Death Certificates

1
Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy
2
Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy
3
Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy
*
Author to whom correspondence should be addressed.
Co-last authors. Equally contributed to this work.
J. Clin. Med. 2020, 9(11), 3459; https://doi.org/10.3390/jcm9113459
Received: 28 September 2020 / Revised: 13 October 2020 / Accepted: 22 October 2020 / Published: 27 October 2020
Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed. View Full-Text
Keywords: death certificates; COVID-19; comorbidities death certificates; COVID-19; comorbidities
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MDPI and ACS Style

Grippo, F.; Navarra, S.; Orsi, C.; Manno, V.; Grande, E.; Crialesi, R.; Frova, L.; Marchetti, S.; Pappagallo, M.; Simeoni, S.; Di Pasquale, L.; Carinci, A.; Donfrancesco, C.; Lo Noce, C.; Palmieri, L.; Onder, G.; Minelli, G.; Group, I.N.I.o.H.C.-1.M. The Role of COVID-19 in the Death of SARS-CoV-2–Positive Patients: A Study Based on Death Certificates. J. Clin. Med. 2020, 9, 3459. https://doi.org/10.3390/jcm9113459

AMA Style

Grippo F, Navarra S, Orsi C, Manno V, Grande E, Crialesi R, Frova L, Marchetti S, Pappagallo M, Simeoni S, Di Pasquale L, Carinci A, Donfrancesco C, Lo Noce C, Palmieri L, Onder G, Minelli G, Group INIoHC-1M. The Role of COVID-19 in the Death of SARS-CoV-2–Positive Patients: A Study Based on Death Certificates. Journal of Clinical Medicine. 2020; 9(11):3459. https://doi.org/10.3390/jcm9113459

Chicago/Turabian Style

Grippo, Francesco, Simone Navarra, Chiara Orsi, Valerio Manno, Enrico Grande, Roberta Crialesi, Luisa Frova, Stefano Marchetti, Marilena Pappagallo, Silvia Simeoni, Lucilla Di Pasquale, Annamaria Carinci, Chiara Donfrancesco, Cinzia Lo Noce, Luigi Palmieri, Graziano Onder, Giada Minelli, and Italian National Institute of Health COVID-19 Mortality Group. 2020. "The Role of COVID-19 in the Death of SARS-CoV-2–Positive Patients: A Study Based on Death Certificates" Journal of Clinical Medicine 9, no. 11: 3459. https://doi.org/10.3390/jcm9113459

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